Primary and Secondary Syphilis

• After 6, 12, and 24 months of treatment, reexamine the patient and recommend a follow-up quantitative nontreponemal titer. If the patient is asymptomatic, yet has a fourfold increase in nontreponemal titer or persistent or recurrent symptoms are observed, order an HIV test and a lumbar puncture; if the patient is HIV-positive, suggest an infectious disease consult.

Primary or secondary syphilis diagnosed and treated with benzathine penicillin G, 2.4 million units IM (single dose)'

Follow-up al 6 months: repeat clinical examination and quantitative non-treponemal test titers

Persistent or recurrent clinical signs or symptoms

No signs or symptoms, but persistent fourfold increase in non-terponemal titers

No signs or symptoms, and fourfold decrease in non-treponemal test titers

HIV testing and lunbar punctur©


Follow up in 6 month3: repeat clinical examination

Infectious disease consultation

Lumbar puncture negative

Lumbar puncture findings compatible with neurosyphilis

Benzathine pencillin G, 2.4 million units IM orce weekly for 3 weeks (3 doses)*

Treat for neurosyphilis as per recommendations5

Follow-up in 6 months: repeat clinical examination and nontreponemal test titers

FIGURE 80-2. Patient care monitoring for syphilis. (From Brown D, Frank J. Diagnosis and Management of Syphilis. Am Fam Physician. 2003;68(2):283-290.) (a See text for alternative treatment recommendations for nonpregnant penicillin-allergic patients. See text for treatment recommendations for neurosyphilis.)

• In patients who are both negative for HIV and the lumbar puncture, administer benzathine penicillin G 2.4 million units intramuscularly once weekly for three additional weeks. Perform a patient follow-up in 6 months including a clinical examination and another nontreponemal titer. In HIV-negative patients with lumbar puncture findings compatible with neurosyphilis, treat the patient accordingly for neurosyphilis.

• Six months after the original diagnosis, institute a standard clinical follow-up exam in patients who show no symptomatology and a fourfold decrease in nontreponemal titers. By testing and observing the patient for signs of remission, you may be able to initiate proper treatment or recommend a consult in a timely fashion, thereby decreasing the propensity of the patient's condition to advance to a higher stage.

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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