Syphilis management for latent stage
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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
- Latent syphilis is defined as syphilis characterized by seroreactivity without other evidence of disease.
- Patients who have latent syphilis and who acquired syphilis during the preceding year are classified as having early latent syphilis. Patients' conditions can be diagnosed as early latent syphilis if, during the year preceding the evaluation, they had
- a documented seroconversion or fourfold or greater increase in titer of a nontreponemal test;
- unequivocal symptoms of primary or secondary syphilis; or
- a sex partner documented to have primary, secondary, or early latent syphilis.
- In addition, for persons whose only possible exposure occurred during the previous 12 months, reactive nontreponemal and treponemal tests are indicative of early latent syphilis.
- In the absence of these conditions, an asymptomatic person should be considered to have late latent syphilis or syphilis of unknown duration.
- Nontreponemal serologic titers usually are higher during early latent syphilis than late latent syphilis. However, early latent syphilis cannot be reliably distinguished from late latent syphilis solely on the basis of nontreponemal titers.
- All patients with latent syphilis should have careful examination of all accessible mucosal surfaces (i.e., the oral cavity, perianal area, perineum and vagina in women, and underneath the foreskin in uncircumcised men) to evaluate for internal mucosal lesions.
- All patients who have syphilis should be tested for HIV infection.
CDC Recommendations: Pharmacotherapy [3]
- Because latent syphilis is not transmitted sexually, the objective of treating patients with this stage of disease is to prevent complications.
- Although clinical experience supports the effectiveness of penicillin in achieving this goal, limited evidence is available to guide choice of specific regimens.
- The following regimens are recommended for penicillin nonallergic patients who have normal CSF examinations (if performed).
- Available data demonstrate no enhanced efficacy of additional doses of penicillin G, amoxicillin, or other antibiotics in early syphilis, regardless of HIV status.
- Infants and children aged more than 1 month who have been diagnosed with syphilis should have a CSF examination to exclude neurosyphilis.
- In addition, birth & maternal medical records should be reviewed to assess whether children have congenital or acquired syphilis.
- Older children with acquired latent syphilis should be evaluated as described for adults and treated using the following pediatric regimens.
- These regimens are for penicillin non-allergic children who have acquired syphilis and who have normal CSF examination results.
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Recommended Regimen for AdultsEarly Latent Syphilis1. Benzathine penicillin G 2.4 million units IM in a single dose. Late Latent Syphilis or Latent Syphilis of Unknown Duration1. Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervals. Recommended Regimen for Infants and ChildrenEarly Latent Syphilis1. Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of 2.4 million units in a single dose. Late Latent Syphilis or Latent Syphilis of Unknown Duration1. Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of 2.4 million units, administered as 3 doses at 1-week intervals (total 150,000 units/kg up to the adult total dose of 7.2 million units). |
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