Syphilis
Red flags
Consider urgent referral for patients with the following:
- Confusion
- Neurological involvement
- Herxheimer reaction after initiating treatment
Features that may lead to more urgent categorisation
- Features primary or secondary syphilis
- Anaphyllactic sensitivity to penicillin
Syphilis has become much more common over the last 10-15 years. Syphilis infection can be categorised into:
- Early (less than 2 years duration) include primary, secondary and early latent
- Late (over 2 years duration)
Other important information for referring practitioners
Lifestyle changes
- Obtain full sexual history and contact tracing or refer to sexual health for follow up of contacts
- Advise re infectivity
Medical management
Most cases can be managed in primary care. Advice can be obtained by contacting Queensland Sexual Health Services at Biala Sexual Health and HIV Service, 270 Roma St, Ph: (07) 3837 5611.
- Definitive diagnosis of syphilis requires the following:
- Reactive non-treponemal test: Rapid plasma regain (RPR) – this is the most commonly used test – or venereal diseases reference laboratory (VDRL), and
- At least 1 reactive specific treponemal test, such as:
- Treponema pallidum agglutination/haemagglutination (TPPA/TPHA)
- Fluorescent treponemal antibody-absorption (FTA-ABS) test
- Enzyme immune assay (EIA)
- At least 1 reactive specific treponemal test, such as:
- Demonstrated seroconversion of specific treponemal test within 12 months of a negative test
- Detection of T. pallidum by nucleic acid test (NAT) from a clinical specimen
- Reactive non-treponemal test: Rapid plasma regain (RPR) – this is the most commonly used test – or venereal diseases reference laboratory (VDRL), and
- Definitive diagnosis of re-infection requires:
- Significant increase (4 fold) in non-treponemal test titre (most commonly RPR) in a previously infected individual
- Treponemal specific tests tend to remain positive for life and once positive are of no value in determining response to treatment or reinfection
- Atypical results may occur in HIV patients
- Seroconversion after contact can take up to 3 months
- Treatment should be offered to the following:
- Symptomatic patients (with typical ulcer or secondary lesions) with:
- Rising RPR titre (4 fold) before treatment
- Reactive RPR & specific test with evidence of negative serology within the previous 2 years
- Asymptomatic patients with:
- Reactive treponemal test (EIA, TPPA, TPHA or FTA-ABS) and one of the following:
- Negative serology within the last 2 years
- 4-fold increase in RPR titre on subsequent testing
- Reactive treponemal test (EIA, TPPA, TPHA or FTA-ABS) and one of the following:
- Symptomatic patients (with typical ulcer or secondary lesions) with:
- Treatment is Penicillin G for all stages
- Early syphilis (primary , secondary and early latent)
- Benzathine penicillin G 1.8gm imi (given as 0.9gm into each buttock) or
- Procaine penicillin G 1.0gm imi daily for 10 days or
- Doxycycline 100mg bd for 14 days if penicillin allergic and not pregnant
- This treatment is inferior to penicillin
- Late latent syphilis
- Benzathine penicillin G 1.8gm imi 3 doses given 1 week apart
- Procaine penicillin G 1.0gm imi daily for 15 days
- Doxycycline 100mg bd for 28 days if penicillin allergic and not pregnant
- This treatment is inferior to penicillin
- Early syphilis (primary , secondary and early latent)
- Treatment of contacts should be with Benzathine Penicillin G 1.8gm imi without waiting for results of serology as this can be negative for up to 3 months
- If there are concerns regarding neurological involvement the patient should be referred for consideration of lumbar puncture
Referral requirements
A referral may be rejected without the following information.
Send referral
Hotline: 1300 364 938
Fax: 1300 364 952
Electronic: eReferral system
Mail: Metro North Central Patient Intake
Aspley Community Centre
776 Zillmere Road
ASPLEY QLD 4034
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