Syphilis management for tertiary stage: Difference between revisions
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[[Syphilis pathophysiology#Tertiary syphilis|Tertiary syphilis]] refers to [[Syphilis physical examination#Tertiary syphilis: Gumma|gumma and cardiovascular syphilis]] but not to all [[Neurosyphilis#Clinical presentation: Four clinical types|neurosyphilis]]. Patients who are not [[Syphilis medical therapy#Pencillin allergy|allergic to penicillin]] and have no evidence of [[neurosyphilis]] should be treated with the following regimen. | [[Syphilis pathophysiology#Tertiary syphilis|Tertiary syphilis]] refers to [[Syphilis physical examination#Tertiary syphilis: Gumma|gumma and cardiovascular syphilis]] but not to all [[Neurosyphilis#Clinical presentation: Four clinical types|neurosyphilis]]. Patients who are not [[Syphilis medical therapy#Pencillin allergy|allergic to penicillin]] and have no evidence of [[neurosyphilis]] should be treated with the following regimen. | ||
==CDC Recommendations: Pharmacotherapy [http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5912a1.htm]== | ==Management of Tertiary Syphilis== | ||
===CDC Recommendations: Pharmacotherapy [http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5912a1.htm]=== | |||
{{cquote| | {{cquote| | ||
====Recommended Regimen==== | ====Recommended Regimen==== | ||
'''1.''' [[Penicillin#Benzylpenicillin (penicillin G)|Benzathine penicillin G]] 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervals.}} | '''1.''' [[Penicillin#Benzylpenicillin (penicillin G)|Benzathine penicillin G]] 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervals.}} | ||
==Other Management Considerations== | ===Other Management Considerations=== | ||
Patients who have [[Syphilis history and symptoms#Tertiary syphilis|symptomatic late syphilis]] should be given a [[Syphilis laboratory tests#CSF analysis|CSF examination]] before therapy is initiated. | Patients who have [[Syphilis history and symptoms#Tertiary syphilis|symptomatic late syphilis]] should be given a [[Syphilis laboratory tests#CSF analysis|CSF examination]] before therapy is initiated. | ||
==Special | ===Special Considerates=== | ||
====Penicillin Allergy: Alternative regimen==== | ====Penicillin Allergy: Alternative regimen==== | ||
Patients [[Syphilis medical therapy#Pencillin allergy|allergic to penicillin]] should be treated in consultation with an infectious disease specialist. | Patients [[Syphilis medical therapy#Pencillin allergy|allergic to penicillin]] should be treated in consultation with an infectious disease specialist. | ||
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Pregnant patients who are allergic to penicillin should be [[desensitized]] and treated with [[penicillin]]. | Pregnant patients who are allergic to penicillin should be [[desensitized]] and treated with [[penicillin]]. | ||
==Follow-Up== | ===Follow-Up=== | ||
Limited information is available concerning clinical response and follow-up of patients who have [[Syphilis pathophysiology#Tertiary syphilis|tertiary syphilis]]. | Limited information is available concerning clinical response and follow-up of patients who have [[Syphilis pathophysiology#Tertiary syphilis|tertiary syphilis]]. | ||
Revision as of 20:38, 17 December 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]
Overview
Tertiary syphilis refers to gumma and cardiovascular syphilis but not to all neurosyphilis. Patients who are not allergic to penicillin and have no evidence of neurosyphilis should be treated with the following regimen.
Management of Tertiary Syphilis
CDC Recommendations: Pharmacotherapy [3]
“ |
Recommended Regimen1. Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervals. |
” |
Other Management Considerations
Patients who have symptomatic late syphilis should be given a CSF examination before therapy is initiated.
Special Considerates
Penicillin Allergy: Alternative regimen
Patients allergic to penicillin should be treated in consultation with an infectious disease specialist.
Pregnancy
Pregnant patients who are allergic to penicillin should be desensitized and treated with penicillin.
Follow-Up
Limited information is available concerning clinical response and follow-up of patients who have tertiary syphilis.