• Syphilis:
  • FTA-ABs remain reactive if prior syphilis infection
  • Primary Syphilis - Chancre at site of infection (painless) WITH REGIONAL lad
  • Secondary Syphilis - Disseminated rash, generalized lymphadenopathy
  • Latent Syphilis - Asymptomatic
  • Tertiary Syphilis - Gummas, cardiovascular syphilis, neurologic complications
  
  

  Posted 10/18/16 02:38:16 PM by Adam Faye

• Syphilis Treatment:
  • Primary/Secondary - Benzathine Pen G, 2.4 million units injection in gluteal region x 1 dose
  • Early Latent (<1 year) - Benzathine Pen G, 2.4 million units injection in gluteal region x 1 dose
  • Late Latent (>1 year)/Syphilis of Unknown Duration - Benzathine Pen G, 2.4 million units injection in gluteal region x 1 dose/week for 3 total doses
  • Neurosyphilis - Aqueous crystalline Pen G 3-4 million units q4hr IV x 10-14 days
  
  
  
  

  Posted 10/18/16 02:45:04 PM by Adam Faye

• Pts. with neuro findings should have an LP to rule out neurosyphilis.
  Guidelines vary among whether patients with HIV and Syphilis WITHOUT neuro findings should have an LP to rule out Neurosyphilis:
  • Data suggests that HIV patients with syphilis often have evidence of disease in CNS, but if patient are asymptomatic unclear benefit of identification/treatment
  • Higher likelihood of syphilis in CNS in HIV patients with CD4<350 or RPR > 1:32
  • CSF VDRL --> Specific but NOT Sensitive
  • CSF FAT-ABS --> Sensitive but NOT Specific
  
  

  Posted 10/18/16 03:05:45 PM by Adam Faye

• The Jarisch-Herxheimer reaction is an acute febrile reaction that usually occurs within the first 24 hours after any therapy for syphilis (endotoxin release). The fever may be accompanied by headache, myalgias, rigors, sweating, hypotension, and the worsening of rash if initially present.
  
  

  Posted 10/18/16 03:05:57 PM by Adam Faye

• Repeat Serologies -> decrease 4-fold (2 dilutions) by :
  • 6-12 months for Primary, Secondary, or Early Latent
  • 12-24 months for Late Latent/Unknown Duration
  
  
  Neurosyphillis – CSF studies q6months (WBC/Protein should decline, but VDRL may remain reactive for 2 years)
  
  

  Posted 10/18/16 03:07:06 PM by Adam Faye

Created by Christopher Kelly

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It is not meant to replace the advice of a health professional.