Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:50

1398 Syphilis

Special Considerations

■Pregnancy: PCN is only recommended therapy; if PCN allergic, skin

test and desensitize; consider 4.8 mil U of Benzathine PCN for treat-

ment of patients with early (primary, secondary, early latent) disease

or those with ultrasound findings consistent with fetal syphilis

■HIV: for primary, secondary, and early latent disease, consider addi-

tional doses of benzathine PCN (7.2 mil U total)

Side Effects & Contraindications

■Penicillin: side effects: hypersensitivity reaction, rash, diarrhea, GI

distress; contraindicated in penicillin allergy; pregnancy=B

■Doxycycline/Tetracycline: side effects: GI distress, photosensitivity,

erosive esophagitis; contraindicated in pregnancy (D) and growing

children

follow-up

Primary, Secondary, Early Latent

■Re-examine clinically and serologically at 6 and 12 mo (3, 6, 9, 12,

and 24 in HIV+)

■Repeat serology in pregnant women in 3rd trimester and at delivery

■Recommend repeat HIV test and CSF evaluation if. –

➣Signs or symptoms persist

➣Non-treponemal titers fail to decrease four-fold in 6 mo

➣Non-treponemal titers increase four-fold

■Consider CSF evaluation at 6 mo in HIV+patients

Late Latent

■Repeat non-treponemal serologic tests at 6, 12, and 24 mo (re-

evaluate clinically and serologically at 6, 12, 18, and 24 in HIV+)

■Repeat HIV test and evaluate CSF if:

➣Signs or symptoms develop

➣Non-treponemal titers fail to decrease four-fold in 12–24 mo

➣Non-treponemal titers increase four-fold

Neurosyphilis

■If CSF abnormal initially, repeat CSF evaluations every 6 months

■Consider retreatment if:

➣Elevated CSF WBC persists after 6 months

➣CSF is remains abnormal after 2 years

complications and prognosis

■Jarisch-Herxheimer reaction: develops within 24 h of treatment; self-

limited but potentially severe; 50% primary, 90% secondary, and 25%