eMedicine Specialties > Emergency Medicine > Infectious Diseases

Syphilis: Follow-up

Author: Maria M Diaz, MD, Staff Physician, Department of Emergency Medicine, State University of New York Downstate Medical Center
Coauthor(s): Richard H Sinert, DO, Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center
Contributor Information and Disclosures

Updated: Jul 17, 2009

Follow-up

Further Outpatient Care

  • Patients treated for primary and secondary syphilis should have follow-up VDRL at 3, 6, and 12 months after treatment. Patients with HIV should be monitored closely, as they are known to have more rapid progression of disease.
    • Most patients with primary syphilis who are treated adequately have a nonreactive VDRL within 1 year, and almost all patients treated for secondary syphilis have a negative VDRL result within 2 years.
    • A small minority of patients remain seropositive in spite of successful treatment.
    • Therapy is considered a failure if the signs and symptoms of syphilis return.
    • This occurs when the titer of the nontreponemal test increases 4-fold or a 4-fold decrease from the initial VDRL titer does not occur within 1 year.
  • Patients with neurosyphilis should have follow-up at 6-month intervals for at least 3 years with physical examinations and CSF and serologic testing.
  • Pregnant women treated for syphilis should have monthly VDRL testing for the duration of their pregnancy.

Deterrence/Prevention

  • Safe sex practices
  • Use of condoms
  • Partner testing
  • Prenatal testing

Complications

  • Cardiovascular disease
  • CNS disease
  • Membranous glomerulonephritis
  • Paroxysmal cold hemoglobinemia
  • Irreversible end-organ damage
  • Jarisch-Herxheimer reaction

Prognosis

  • The prognosis in treated primary and secondary syphilis is excellent. T pallidum remains highly responsive to the penicillins and cure is likely.
  • The prognosis in tertiary syphilis is less sanguine, although a significant number of patients demonstrate cure with antibiotic therapy.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to conduct testing for syphilis because the lesion or rash is suggestive of another entity is the major potential pitfall in patients with syphilis.
    • Given the ability of syphilis to masquerade as a number of illnesses, routine serologic testing for syphilis is prudent when rendering a diagnosis of pityriasis rosea or another generalized rash. Similar logic applies to genital lesions.
    • If the alternative diagnosis is an STD, such as chancroid, good medical care includes testing for syphilis.
    • Regardless of the symptoms, testing for coexisting syphilis is recommended when diagnosing other STDs, such as urethritis or cervicitis. An increase in attention to this issue in women with suspected STDs is needed.

Special Concerns

  • Pregnancy
    • The penicillin regimen appropriate to the stage of disease is the only treatment recommended.
    • Do not administer tetracycline or doxycycline during pregnancy.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Todd A McGregor, MD, Bradley Pulver, MD, and Allison J Richard, MD, to the development and writing of this article.



More on Syphilis

Overview: Syphilis
Differential Diagnoses & Workup: Syphilis
Treatment & Medication: Syphilis
Follow-up: Syphilis
Multimedia: Syphilis
References
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References

  1. Primary and secondary syphilis--United States, 2003-2004. MMWR Morb Mortal Wkly Rep. Mar 17 2006;55(10):269-73. [Medline].

  2. Harrison LW. The Oslo study of untreated syphilis, review and commentary. Br J Vener Dis. Jun 1956;32(2):70-8. [Medline].

  3. Rockwell DH, Yobs AR, Moore MB Jr. The Tuskegee Study of Untreated Syphilis; the 30th year of Observation. Arch Intern Med. Dec 1964;114:792-8. [Medline].

  4. Sexually Transmitted Disease Surveillance, 2007. Atlanta, Georgia: Centers for Disease Control and Prevention; 2008. 33. [Full Text].

  5. [Guideline] Screening for syphilis infection in pregnancy: U.S. Preventive services task force reaffirmation recommendation statement. Ann Intern Med. May 19 2009;150(10):705-9. [Medline]. [Full Text].

  6. [Guideline] Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. Aug 4 2006;55:1-94. [Medline]. [Full Text].

  7. [Guideline] U.S. Preventive Services Task Force. Screening for Syphilis Infection. Recommendation Statement. 2004. [Full Text].

  8. Bai ZG, Yang KH, Liu YL, et al. Azithromycin vs. benzathine penicillin G for early syphilis: a meta-analysis of randomized clinical trials. Int J STD AIDS. Apr 2008;19(4):217-21. [Medline].

  9. [Guideline] Calonge N. Screening for syphilis infection: recommendation statement. Ann Fam Med. Jul-Aug 2004;2(4):362-5. [Medline]. [Full Text].

  10. Centers for Disease Control and Prevention. Primary and Secondary Syphilis -- United States, 2003-2004. MMWR Morb Mortal Wkly Rep. March 17, 2006;55(10):269-273. [Full Text].

  11. Csonka GW, Oates JK. Sexually Transmitted Diseases. WB Saunders; 1990:227-76.

  12. Department of Health and Human Services. Sexually Transmitted Diseases Surveillance 2004 Report. Syphilius Surveillance Report. 2005;[Full Text].

  13. Hoeprich PD, Jordan MC. Infectious Diseases. 4th ed. Lippincott-Raven; 1989:666-83.

  14. Isselbacher KJ, Braunwald E, Wilson JD. Harrison's Principles of Internal Medicine. 13th ed. McGraw-Hill: 1994:726-37.

  15. Kent ME, Romanelli F. Reexamining syphilis: an update on epidemiology, clinical manifestations, and management. Ann Pharmacother. Feb 2008;42(2):226-36. [Medline].

  16. Rosahn PD. Autopsy studies in syphilis; a monograph. Washington: U.S. Dept. of Health, Education, and Welfare, Public Health Service, Bureau of State Services, Communicable Disease Center, Venereal Disease Branch; 1948. U.S. Public Health Service Publication.

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Further Reading

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Keywords

syphilis, syphilis treatment, syphilis symptoms, syphilis symptoms, STDs, sexually transmitted diseases, Treponema pallidum, T pallidum, primary syphilis, secondary syphilis, early latent syphilis, late latent syphilis, tertiary syphilis, gummatous syphilis, cardiovascular syphilis, neurosyphilis, advanced syphilis, chancre, genital chancre, inguinal adenitis, condylomata lata, the great impostor

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Contributor Information and Disclosures

Author

Maria M Diaz, MD, Staff Physician, Department of Emergency Medicine, State University of New York Downstate Medical Center
Maria M Diaz, MD is a member of the following medical societies: Phi Beta Kappa
Disclosure: Nothing to disclose.

Coauthor(s)

Richard H Sinert, DO, Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center
Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Joseph J Sachter, MD, FACEP, Consulting Staff, Department of Emergency Medicine, Muhlenberg Regional Medical Center
Joseph J Sachter, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Medical Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Eric L Weiss, MD, DTM&H, Director of Stanford Travel Medicine, Medical Director of Stanford Lifeflight, Assistant Professor, Departments of Emergency Medicine and Infectious Diseases, Stanford University School of Medicine
Eric L Weiss, MD, DTM&H is a member of the following medical societies: American College of Emergency Physicians, American College of Occupational and Environmental Medicine, American Medical Association, American Society of Tropical Medicine and Hygiene, Physicians for Social Responsibility, Southeastern Surgical Congress, Southern Association for Oncology, Southern Clinical Neurological Society, and Wilderness Medical Society
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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