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.