Syphilis

Syphilis

Management of sexual contacts

contact partners from the past 3 months if the patient has primary syphilis, and over a longer period if they have secondary syphilis (eg 6 months) or latent syphilis (eg 12 months).

Perform serological testing of sexual contacts and then presumptively treat them with:

benzathine benzylpenicillin 2.4 million units intramuscularly [Note 2], as a single dose.

Investigations for syphilis

Diagnosis of active syphilis is confirmed with both:

• a positive nontreponemal test result (such as rapid plasma reagin [RPR] test)
• a positive treponemal test result (such as treponemal enzyme immunoassay [EIA], T. pallidum particle agglutination test [TPPA] or T. pallidum haemagglutination assay [TPHA]).

Neither test alone is adequate for diagnosis.

Early syphilis

For treatment of early syphilis, use:

1	benzathine benzylpenicillin 2.4 million units intramuscularly [Note 1], as a single dose

Late latent syphilis

Late latent syphilis is defined as latent (asymptomatic) syphilis of longer than 2 years’ duration, or of unknown duration. Seek expert advice about the need for and interpretation of lumbar puncture. This is particularly important for patients who have previously been treated for syphilis or for patients with HIV infection. If neurosyphilis is confirmed, treat as for tertiary syphilis.

For treatment of late latent syphilis, use:

1	benzathine benzylpenicillin 2.4 million units intramuscularly [Note 3], once weekly for 3 weeks