Because treatment failure often can’t be reliably distinguished from reinfection with T. pallidum, a CSF analysis also must be performed; therapy needs to be guided by CSF findings. Acyclovir, famciclovir, and valacyclovir appear equally effective for episodic therapy of genital herpes, however famciclovir appears somewhat less effective for suppression of viral shedding (163–167,173). Ease of administration and price also are necessary concerns for extended treatment. The preparation used (i.e., benzathine, aqueous procaine, or aqueous crystalline), dosage, and length of treatment depend upon the stage and clinical manifestations of the disease. Such manifestations are unusual after the primary 12 months of infection. In geographic areas wherein the prevalence of HIV is excessive, individuals who have main or secondary syphilis must be retested for acute HIV in three months if the first HIV test consequence was negative. Skin testing for penicillin allergy is perhaps useful in some circumstances wherein the reagents and experience are available to perform the test adequately (see Management of Persons Who’ve a History of Penicillin Allergy).
Persons who have had sexual contact with a one who receives a diagnosis of main, secondary, or early latent syphilis within ninety days preceding the prognosis should be handled presumptively for early syphilis, even when serologic test outcomes are unfavourable. In this occasion, a repeat nontreponemal test in 2-four weeks is beneficial to guage for early infection. However, clinical trial data have demonstrated that 15%-20% of individuals with primary and secondary syphilis treated with the advisable therapy is not going to obtain the fourfold decline in nontreponemal titer used to define response at 1 12 months after therapy (406,409). Serologic response to treatment appears to be associated with several elements, including the person’s stage of syphilis (earlier levels are more likely to decline fourfold and become negative) and preliminary nontreponemal antibody titers (lower titers are much less prone to decline fourfold than increased titers) (409). Optimal management of individuals who’ve lower than a fourfold decline in titers after therapy of syphilis is unclear. Pregnant girls with syphilis in any stage who report penicillin allergy must be desensitized and handled with penicillin (see Management of Persons Who have a History of Penicillin Allergy). Persons who’ve syphilis and signs or signs suggesting neurologic illness (e.g., cranial nerve dysfunction, meningitis, stroke, and hearing loss) or ophthalmic disease (e.g., uveitis, iritis, neuroretinitis, and optic neuritis) ought to have an analysis that includes CSF analysis, ocular slit-lamp ophthalmologic examination, and otologic examination.
Data to help use of alternatives to penicillin in the treatment of main and secondary syphilis are restricted. Nontreponemal test titers usually decline after therapy and may change into nonreactive with time; nevertheless, in some individuals, nontreponemal antibodies can persist for a protracted time period, a response referred to because the “serofast reaction.” Most patients who’ve reactive treponemal assessments can have reactive tests for the remainder of their lives, regardless of treatment or illness exercise. The prognosis of neurosyphilis depends upon a mix of cerebrospinal fluid (CSF) tests (CSF cell count or protein and a reactive CSF-VDRL) within the presence of reactive serologic check results and neurologic indicators and symptoms. As well as, for persons with reactive nontreponemal and treponemal assessments whose solely potential exposure occurred in the course of the previous 12 months, early latent syphilis could be assumed. Infants and youngsters aged ≥1 month with major and secondary syphilis needs to be managed by a pediatric infectious-illness specialist and evaluated for sexual abuse (e.g., by way of session with little one-safety companies) (see Sexual Assault or Abuse of kids).
These partners ought to be managed as if the index case had early syphilis. The following intercourse companions of individuals with syphilis are thought-about in danger for infection and should be confidentially notified of the publicity and want for analysis: partners who’ve had sexual contact within 1) three months plus the duration of signs for individuals who obtain a diagnosis of primary syphilis, 2) 6 months plus duration of symptoms for these with secondary syphilis, and 3) 1 year for persons with early latent syphilis. The Jarisch-Herxheimer reaction is an acute febrile response continuously accompanied by headache, myalgia, fever, and other symptoms that may happen inside the primary 24 hours after the initiation of any therapy for syphilis. CSF laboratory abnormalities are widespread in persons with early syphilis and are of unknown significance within the absence of neurologic signs or signs (402). CSF-VDRL is very specific however insensitive. If the nontreponemal take a look at is negative, the laboratory ought to perform a unique treponemal test (preferably one primarily based on different antigens than the unique test) to confirm the outcomes of the initial take a look at. Invasion of CSF by T. pallidum accompanied by CSF laboratory abnormalities is widespread among adults who have primary or secondary syphilis (402). In the absence of clinical neurologic findings, no proof supports variation from the advisable therapy regimen for primary and secondary syphilis.