Population: Adults, infants and children with syphilis.
Organizations
IDSA 2011, CDC 2021
Recommendations
Evaluation
–Diagnosis: Test all persons who have syphilis for HIV, offer PrEP and retest for HIV in 3 mo if primary test is negative.
–Cerebrospinal fluid (CSF) analysis is indicated if:
• Early syphilis infection and neurologic symptoms.
• Late latent syphilis.
–Obtain CSF examination, for patients with early syphilis who do not achieve a >4-fold decline in RPR titers within 12 mo.
Management
–See treatment section in Table 26–1.
–Use penicillin G 2.4 million units IM for early syphilis.
–Doxycycline is a second-line therapy for early syphilis in penicillin-allergic patients.
–Ceftriaxone is a second-line therapy for neurosyphilis in penicillin-allergic patients.
–Evaluate and treat sexual partners within preceding 90 d.
–If re-treatment is necessary, use penicillin G 2.4 million units IM × 3 wk, unless neurological involvement.
Practice Pearls
• Penicillin (PCN) G is the only treatment in pregnancy. If PCN allergy, pursue desensitization therapy.
• Avoid doxycycline in pregnancy.
• Infants and children: Benzathine PCN G 50,000 U/kg IM up to adult dose 2.4 million units. If secondary syphilis is suspected, consult infectious disease specialist.
• Treat HIV-positive patients with primary or secondary syphilis as HIV-negative persons.
Sources
–http://cid.oxfordjournals.org/content/53/suppl_3/S110.abstract
–https://www.cdc.gov/std/treatment-guidelines/p-and-s-syphilis.htm