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Dip GUM > Syphilis > Flashcards

Syphilis Flashcards

1
Q

What causes Syphillis

A

Treponema pallidum spirochete bacterium

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2
Q

Symptoms of primary Syphilis

A

Painless ulcer on vulva / cervix Englarged groin / inguinal lymph nodes

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3
Q

Symptoms of secondary Syphilis

A

rash - Maculopapular (70%) papular (12%), macular (10%) rash can be on palms and soles - not usually itchy can cause alopecia generalised lymphadenopathy. mucous patches (buccal, lingual and genital) condylomata lata - warm, moist areas Less common: hepatitis; glomerulonephritis, splenomegaly, 1–2% develop neurological complications

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4
Q

Treatment of early Syphilis (primary, secondary and early latent)

A

Benzathine penicillin G IM 2.4 MU IM single dose

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5
Q

Treatment of Late latent, cardiovascular and gummatous syphilis

A

Benzathine penicillin G 2.4 MU IM weekly for 3 weeks (three doses)

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6
Q

Define late latent syphilis

A

Secondary syphilis resolves spontaneously and the disease enters an asymptomatic latent stage. Defined as early within two years, and late thereafter

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7
Q

Examination required for symptomatic late syphilis disease clinical examination

A

clinical examination as indicated, with attention to: - Skin - Musculoskeletal system (congenital) - Cardiovascular system (for signs of aortic regurgitation) - Nervous system (general paresis: dysarthria, hypotonia, intention tremor, and reflex abnormalities; Tabes dorsalis: pupil abnormalities, impaired reflexes, impaired vibration and joint position sense, sensory ataxia and optic atrophy)

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8
Q

Transmission route of syphilis

A
  • direct contact with an infectious lesion - vertical transmission (trans-placental passage) during pregnancy rarer - Injecting drug use - blood transfusion outside of UK
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9
Q

What proportion of sexual contacts of infectious syphilis develop the disease

A

1/3 of sexual contacts of infectious syphilis will develop the disease (transmission rates of 10–60% are cited)

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10
Q

What is the usual site of entry for syphilis?

A
  • typically genital in hetero-sexual patients - 1/3 of transmissions among MSM may be extra- genital = anal, rectal, oral
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11
Q

What proportion of syphilis is estimated to be acquired via oral sex?

A

approx 10% (one study)

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12
Q

At what stage of pregnancy is vertical transmission of syphilis most likely to occur?

A

T. pallidum readily crosses the placenta vertical transmission can occur at any stage of pregnancy.

transmission risk is greatest in early syphilis

more common in 2nd and 3rd T

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13
Q

rate of congenital syphilis

A

low 0.0025/ 1000 live births in 2011

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14
Q

Incubation period of syphilis

A

typically 21 days (range 9–90)

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15
Q

describe the classical chancre of syphilis

A

classically anogenital (penile, labial, cervical or peri-anal), single painless indurated clean base discharging clear serum

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16
Q

Appearance of a syphilitic chancre with HIV-1 co-infection

A

may be multiple, deeper persist into the secondary stage of disease

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17
Q

Timeframe for primary syphilitic chancre to resolve

A

ulcers resolve over 3–8 weeks

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18
Q

Timeframe for secondary syphilis development

A

typically 3m after infection

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19
Q

Impact of HIV-1 infection on mucocutaneous manifestations of secondary syphilis

A

No impact

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20
Q

1–2% of patients with secondary syphilis develop neurological complications These typically include…..

A

acute meningitis - (headache, neck stiffness, photophobia, nausea) cranial nerve palsies Eye involvement - uveitis, optic neuropathy, interstitial keratitis, retinal involvement

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21
Q

Duration of secondary syphilis resolving?

A

Secondary syphilis will resolve spontaneously in 3–12 weeks The the disease enters an asymptomatic latent stage.

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22
Q

what is the cut off between early and late latent syphilis?

A

Early latent syohilis is within two years Late latent is >2years thereafter

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23
Q

What % of patients develop a recurrence of secondary disease during the early latent stage?

A

approximately 25%

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24
Q

Time frame for developing tertiary syphilis?

A

around 20–40 years after initial infection

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25
Q

What proportion of patients develop tertiary syphilis?

A

1/3 of untreated patients

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26
Q

Types of tertiary syphilis?

A
  • Gummatous disease (15%) - Cardiovascular (10%) - Late neurological complications (7%)
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27
Q

What is gummatous syphilis?

A

Granulomatous lesions with central necrosis Most often affect skin and bones. Rapidly resolve with treatment

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28
Q

Timeframe for developing gummatous tertiary syphilis?

A

Can occur within 2yr of latency Typically seen after 15 years

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29
Q

Timeframe for developing Cardiovascular tertiary syphilis

A

typically 15–30 years after infection

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30
Q

Proportion of patients who become symptomatic with cardiovascular tertiary syphilis

A

10%

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31
Q

Symptoms of cardiovascular tertiary syphilis

A

Aortitis - Ascending aorta - subsernal pain Aortic regurgitation Heart failure coronary ostial stenosis angina aneurysm.

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32
Q

Timeframe for developing Meningovascular syphilis

A

Typically 5–10 years after infection (may be earlier) Prodrome may occur in the weeks/months prior to stroke

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33
Q

Types of neuro-syphilis

A

Meningovascular Parenchymous - General paresis / 􏰂 Tabes dorsalis Asymptomatic

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34
Q

Symptoms of Meningovascular syphilis

A

Focal arteritis Infectious arteritis may result in ischaemic stroke (middle cerebral artery territory most commonly affected) Meningeal inflammation signs dependent on site of vascular insult Occasional prodrome; headache, emotional lability, insomnia

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35
Q

Symptoms of neurosyphilis causing general paresis

A

Progressive dementia Initial forgetfulness Personality change Seizures and hemiparesis may occur (late) Emotional lability Psychosis

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36
Q

Timeframe for developing neurosyphilis causing general paresis

A

10–25 years after infection

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37
Q

Cause of symptoms from neurosyphilis causing general paresis

A

cortical neuronal loss

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38
Q

Symptoms of neurosyphilis causing tabes dorsalis

A

lightning pains areflexia paraesthesia sensory ataxia Charcot’s joints mal perforans optic atrophy pupillary changes (Argyll Robertson pupil)

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39
Q

Timeframe for developing neurosyphilis causing tabes dorsalis

A

15–25 years after infection (longest of neurological complications)

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40
Q

Cause of symptoms from neurosyphilis causing tabes dorsalis

A

Inflammation of spinal dorsal column / nerve roots

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41
Q

Which symptoms of neurosyphilis are caused by the loss of the dorsal columns?

A

absent reflexes absent joint position sense absent vibration sense

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42
Q

what are the 2 divisions of congenital syphilis?

A

early (diagnosed in the first two years of life) late (presenting after two years)

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43
Q

In congenital what does the presence of signs at the time of delivery depend upon?

A

duration of maternal infection timing of treatment

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44
Q

What proportion of infants with congenital syphilis are asymptomatic at birth?

A

2/3

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45
Q

Common manifestations of early congenital syphilis?

A

40–60% have one of: - rash - haemorrhagic rhinitis - generalised lymphadenopathy - hepatosplenomegaly - skeletal abnormalities Other signs: condylomata lata, vesiculobullous lesions, osteochondritis, periostitis, pseudoparalysis, mucous patches, perioral fissures, non- immune hydrops, glomerulonephritis, neurological or ocular involvement, haemolysis, thrombocytopenia

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46
Q

Time cut off for early congenital syphilis

A

early congenital syphilis = diagnosed in the first two years of life

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47
Q

Time cut off for late congenital syphilis

A

late congenital syphilis = presenting after two years

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48
Q

Signs of Late congenital syphilis

A

interstitial keratitis Clutton’s joints Hutchinson’s incisors mulberry molars high palatal arch rhagades (peri-oral fissures) sensineural deafness frontal bossing short maxilla protuberance of mandible saddlenose deformity sterno-clavicular thickening paroxysmal cold haemoglobinuria neurological involvement (intellectual disability, cranial nerve palsies)

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49
Q

Cause of signs of Late congenital syphilis

A

A result of chronic and persistent inflammation resembling gummatous disease in adults

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50
Q

Endemic treponemes

A

yaws (T. pallidum pertenue) bejel ( T. pallidum endemicum) pinta (T. pallidum carateum)

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51
Q

Classificaftion of Treponemal antibody tests

A

Treponemal antibody tests classified into: - Non-specific tests (cardiolipin, lipoidal, reagin, non- treponemal): VDRL / RPR test. - Specific (treponemal) tests: EIA, CLIA, TPHA, TPPA, FTA-abs, T. pallidum immunoblot

52
Q

What do most of the specific (treponemal) syphilis tests detect?

A

Most syphilis tests are based on recombinant treponemal antigens They detect treponemal IgG and IgM antibody

53
Q

what is the VDRL test?

A

Venereal Diseases Research Laboratory (VDRL) carbon antigen test = non specific test anti-cardiolipin antibodies

54
Q

What is the RPR Test?

A

rapid plasma reagin (RPR) = non specific test anti-cardiolipin and anti-lecithin antibodies - substances released by cells when they are damaged by T. pallidum

55
Q

What is the EIA Test?

A

Treponemal enzyme immunoassay (EIA) Specific (treponemal) test - detect treponemal IgG and IgM antibody

56
Q

What is the CLIA Test?

A

treponemal chemilumines- cent assay (CLIA) Specific (treponemal) test - detect treponemal IgG and IgM antibody

57
Q

What is the TPHA Test?

A

Treponema pallidum haem- agglutination assay (TPHA) Specific (treponemal) test - detect treponemal IgG and IgM antibody

58
Q

What is the TPPA Test?

A

Treponema pallidum particle agglutination assay (TPPA) Specific (treponemal) test - detect treponemal IgG and IgM antibody

59
Q

What is the FTA-abs test?

A

fluorescent treponemal antibody absorption test (FTA-abs) Specific (treponemal) test - detect treponemal IgG and IgM antibody

60
Q

what are the primary screening tests for syphilis?

A

Primary screening tests 1st = Treponemal test - TPPA or EIA/CLIA (preferably a test that detects both IgG and IgM

61
Q

What test is required if primary syphilis is suspected?

A

Request an anti-treponemal IgM test if primary syphilis is suspected TPPA or EIA/CLIA

62
Q

what are the confirmatory tests for syphilis?

A

Positive screening tests should be confirmed with a different treponemal test. Second specimen always tested to confirm +ve result And sample on day treatment commenced - for documenting peak RPR/VDRL

63
Q

What test is used for assessing serological activity of syphilis

A

A quantitative RPR/VDRL - helps stage the infection and indicate need for treatment

64
Q

What initial RPR level indicates active syphilis?

A

Initial RPR/VDRL titre >16 usually indicates active disease and the need for treatment, RPR titre <16 does not exclude active infection

65
Q

What tests are used for for monitoring the effect of treatment on syphilis infection?

A

A quantitative RPR/VDRL for monitoring the serological response to treatment Specimen taken on the day treatment is started = accurate baseline

66
Q

When is repeat syphilis screening recommended?

A

6 - 12 weeks after a single ‘high risk’ exposure If ongoing / frequent ‘high risk’ exposures - screening for all STIs including HIV + STS is recommended every three months

67
Q

when should testing for syphilis be repeated in a patient with an ulcerative lesion that could be due to syphilis but the dark ground micro or PRC was negative

A

Two weeks after presentation

68
Q

When may false negative syphilis serology occur?

A

Treponemal screening tests are negative before a chancre develops and may be for up to two weeks afterwards. A false-negative RPR/VDRL may occur in secondary or early latent syphilis due to the prozone phenomenon

69
Q

What is the prozone phenomenon?

A

an immunologic phenomenon which causes a false negative syphilis result The effectiveness of antibodies to form immune complexes stops increasing with greater concentrations and decreases with extremely high concentrations

70
Q

How can the prozone phenomenon be avoided

A

Any negative test on undiluted sera should be repeated on diluted sera

71
Q

When may false positive syphilis serology occur?

A

Occasionally false-positive results occur with any of the serological tests for syphilis. False-positive reactivity is more likely in autoimmune disease, older age and injecting drug use.

72
Q

Investigations if Neurosyphilis-syphilis is suspected after examination

A

CT or MRI lumbar puncture (only after CT or MR)

73
Q

what microscopy method is used for syphilis

A

Dark ground microscopy - of exudates from suspicious lesions, or body fluids, e.g. nasal discharge.

74
Q

For diagnosis of syphilis in a newborn infant what sample is recommended

A

Serological tests performed on infant’s blood NOT cord blood I If infant’s serum +ve perform treponemal IgM EIA, RPR/VDRL and TPPA tests on the infant and mother in parallel. Serological tests detecting IgG may be positive due to passive transfer of maternal antibodies whether or not the infant is infected.

75
Q

In diagnosing syphilis in infants - what immunoglobulin type can be passively transferred from the mother

A

IgG Serological tests detecting IgG may be positive due to passive transfer of maternal antibodies whether or not the infant is infected.

76
Q

What test results would indicate a diagnosis of congenital syphilis?

A

Positive IgM EIA test Positive RPR/VDRL test on CSF, A four-fold or greater difference of RPR/ VDRL titre or TPPA titre above that of the mother A four-fold or greater increase in RPR/VDRL or TPPA titre within 3 months of birth, A child >18 months with positive treponemal tests

77
Q

What further investigations should be considered for infants with congenital syphilis?

A

FBC LFT, ALT/AST U+E Lumbar puncture for CSF: WCC, protein, VDRL or RPR, TPPA, X-rays of long bones - osteochondritis and periostitis Ophthalmic assessment - for interstitial keratitis HIV test Chest X-ray for cardiomegaly Cranial U/S scan Audiology for 8th nerve deafness

78
Q

Why is a longer duration of treatment given in late syphilis?

A

Longer duration of treatment in late syphilis On the basis of more slowly dividing treponemes

79
Q

Why is parenteral rather than oral treatment recommended for syphilis?

A

therapy is supervised bioavailability is guaranteed

80
Q

When should steroid treatment be given alongside syphilis treatment?

A

steroid treatment be given alongside syphilis treatment for patients with Cardiovascular or neurological syphilis

81
Q

Treatment regimen for neurosyphilis

A

procaine penicillin 2.4 g (2.4 MU) IM OD for 10–14 days OR benzylpenicillin 10.8–14.4 g daily, given as 1.8–2.4 g IV every 4 h for 14 days: AND probenecid 500 mg PO QDS for 10-14 days AND 40–60mg prednisolone OD for three days starting 24h before the antibiotics

82
Q

What are the potential adverse pregnancy outcomes relating to syphilis?

A

fetal infection usually occurs in 2nd / 3rd trimesters

(But can occur as early as 8–9wk gest)

Polyhydramnios

Miscarriage / stillbirth

Pre-term labour

Fetal hydrops

placental oedema

Congential syphilis

83
Q

Management of positive maternal treponemal serology

A

Urgent referral to GUM MDT - screening laboratory, midwifery, obstetric team, GUM and paediatrics. May be most appropriate that the HIV MDT manages cases of syphilis in pregnancy. Determine if syphilis treated prior to this pregnancy, inadequate previous treatment, reinfection or if this is a new diagnosis of early or late syphilis

84
Q

Management of pregnant women where syphilis was cured prior to current pregnancy

A

RPR/VDRL titres checked at first antenatal booking appointment Repeat later in pregnancy if there is a risk of reinfection If RPR/VDRL excludes re-infection - no further treatment and no need for neonatal testing Re-treatment women with a history of syphilis if there is uncertainty about the adequacy of treatment or a four-fold drop in RPR/VDRL did not occur

85
Q

When is referral to fetal medicine indicated for pregnant women with syphilis?

A

Refer women to fetal medicine if they are treated for syphilis at 26/40 or later. Esp if early syphilis Fetal assessment will help planning of antepartum care as well as neonatal treatment

86
Q

What ultrasound features may suggest Fetal syphilis infection

A

Non- immune hydrops Hepatosplenomegaly

87
Q

maternal antibiotic treatment regimen for syphilis in pregnancy

A

Up to 27+6 /40 - STAT benzathine penicillin G 2.4 MU

From 28/40 to term - Benzathine penicillin G 2.4 MU IM, on days 1 and 8

Due to physiological changes in pregnancy which alter drug pharmacokinetics and may reduce plasma concentrations. Close liaison with obstetrics, midwifery and paediatrics

88
Q

Physical signs of early congenital syphilis?

A

Approximately 50% of neonates with congenital syphilis are normal on initial examination Jaundice Anaemia Generalised lymphadenopathy, Hepatosplenomegaly Non-immune hydrops, Pyrexia, Failure to move an extremity (pseudoparalysis of Parrot), Low birth weight Skin rash (usually maculo-papular); palms / soles red, mottled or swollen Condylomata lata Osteochondritis, periosteitis (elbows, knees, wrists) Ulceration of nasal mucosa, rhinitis

89
Q

What is the risk of a Jarisch-Herxheimer reaction during pregnancy

A

Theoretical increased risk of spontaneous and iatrogenic pre-term delivery and fetal demise May experience uterine contractions - resolve within 24h. Seem secondary to development of fever. Decelerations may occur - usually resolve without early delivery being required

90
Q

Management of the Jarisch-Herxheimer reaction in pregnancy

A

Supportive - As in the non-pregnant woman Antipyretics. No evidence that high-dose oral prednisolone reduces the occurrence of uterine contractions or fetal heart rate abnormalities

91
Q

Maternal follow-up after syphilis treatment in pregnancy

A

May take several months to observe a four-fold drop in RPR/VDRL titre In many pregnancies labour occurs before these periods have elapsed. Women with late syphilis may have serofast RPR/VDRL titres = serological cure may not be demonstrable before birth

92
Q

Non-penicillin alternatives for treating syphilis

A

Doxycycline 100mg PO BD 14 days Ceftriaxone 500mg IM daily10 days (if no anaphylaxis to penicillin) Azithromycin 2g PO STAT or Azithromycin 500mg OD 10/7 Erythromycin 500mg PO QDS 14 days

93
Q

Non-penicillin alternatives for treating syphilis in pregnancy

A

Ceftriaxone 500mg IM OD 10/7 (if no anaphylaxis to penicillin)

Azithromycin 500mg OD 10/7 - uncertain placental penetration - treat baby with penicillin @ birth

Erythromycin 500mg PO QDS 14 days - uncertain placental penetration - treat baby with penicillin @ birth

De-sensitisation to penicillin with immediate subsequent penicillin treatment should be considered

94
Q

Management of infants born to mothers with syphilis

A

Most infected neonates appear normal at birth

RPR/VDRL and IgM tests at birth

Then 3 monthly until negative.

If titres stay stable or increase - treated for congenital syphilis

Benzylpenicillin 25 mg/kg 12hrly IV for 7 days, then 8 hrly on days 8, 9 and 10 (total of 10 days)

95
Q

How common is congenital syphilis?

A

Congenital syphilis is uncommon in the UK

Approximately 10 cases reported annually.

96
Q

When do passively transferred maternal antibodies for syphilis decline?

A

Non-treponema antibodies decline by 3 months and are negative by 6 months

Treponemal antibodies are negative by 18 months

97
Q

Management of an infant born to mothers treated for syphilis less than 4 weeks prior to delivery.

A

Treat infant

Benzyl penicillin sodium 25 mg/kg

12hrly IV for 7 days,

then 8 hrly on days 8, 9 and 10 (total of 10 days)

98
Q

Management of an infant whose mother was treated for syphilis with a non-penicillin regimens.

A

Treat infant

Benzyl penicillin sodium 25 mg/kg

12hrly IV for 7 days,

then 8 hrly on days 8, 9 and 10 (total of 10 days)

99
Q

Impact of HIV on syphilis treatment

A

HIV +ve patients may be at higher risk of treatment failure

HIV means the RPR may not drop as quickly and may become serofast at a higher point

100
Q

Treatment regimen for

Late latent, cardiovascular and gummatous syphilis

A

Benzathine penicillin 2.4 MU IM weekly for 3 weeks = 3 doses

101
Q

Why is IV treatment recommended for treating congenital syphilis?

A

In children IV therapy is preferable due to the pain associated with IM injections.

102
Q

Advice for interruptions in treatment for congenital syphilis

A

If drug administration is interrupted for >1 day tat any point during the treatment then

Re-start the entire course

103
Q

Advice for interruptions in treatment for late syphilis

A

If drug administration is interrupted for >1 day tat any point during the treatment then

Re-start the entire course

104
Q

What is the Jarisch-Herxheimer reaction

A

Jarisch-Herxheimer reaction = An acute febrile illness headache, myalgia, chills, rigours

Resolves within 24 hours.

Common in early syphilis

Usually not clinically significant

unless neurological/ ophthalmic involvement or in pregnancy when it may cause fetal distress

105
Q

management of the Jarisch-Herxheimer reaction

A

Antipyretics Reassurance.

106
Q

although rare, why may the Jarisch-Herxheimer reaction be important in late syphilis

A

Jarisch-Herxheimer reaction is uncommon in late syphilis

BUT potentially life threatening if there is involvement of critical sites (e.g. coronary ostia, larynx and nervous system)

107
Q

what is the recommended steroid regimen prior to treatment of cardiovascular or neurological syphilis

A

Prednisolone

40–60 mg daily for three days

started 24 h before the anti-treponemal antibiotics.

108
Q

what is the procaine reaction

A

Procaine reaction = procaine psychosis / procaine mania / Hoigne’s syndrome

Characterised by fear of impending death

+/- hallucinations

+/- fits

Occurs immediately after injection lasts <20 minutes

109
Q

What causes the procaine reaction

A

Inadvertent IV injection of procaine penicillin

110
Q

Partner notification for patients with primary syphilis

A

PN for sexual partners in the last 3 months

As incubation period is up to 90 days.

111
Q

Partner notification for patients with secondary syphilis

A

PN may have to extend to 2 years

112
Q

Management of asymptomatic contacts of early syphilis

A

offer epidemiological treatment

OR

re-screening for syphilis 12 weeks after their last exposure

113
Q

Follow up after treatment of syphilis

A

Follow-up is to detect possible re-infection and relapse.

non-treponemal titres should drop four-fold

Recommended follow-up with RPR is at 3, 6 and 12 months +/- every 6m if indicated until VDRL/RPR negative or serofast

114
Q

How is syphilis treatment failure determined

A

Treatment failure is characterised by:

  • Four-fold or greater increase in non-treponemal test titre.
  • Recurrence of signs or symptoms
  • Re-infection excluded
115
Q

Management of individuals whose non-treponemal test titres do not decrease four-fold within 12 months of syphilis therapy

A

CSF examination

+ re-treatment If CSF is normal

  • re-treatment with benzathine penicillin G - 2.4 MU IM, weekly, three doses
116
Q

Window period for syphilis testing

A

12 weeks

117
Q

what is the usual route of transmission for neonatal syphilis

A

Usually vertically transmitted

transplacental

most common in 2nd / 3rd T

118
Q

what factors increase the risk of congenital syphilis

A

morther has early STS

mother has high titre RPR / VDRL

maternal co-infection with HIV

mother treated in the 4 weeks before delivery

119
Q

presentations of congential syphilis

A

stillbirth

hydrops

nasal discharge / haemorrhagic rhinitis

nasal ulceration / chondritis / saddle nose

rashes

osteochondritis / periostitis

hepatosplenomegally

failure to thrive

generalised lymphadwnopathy

nephrotic syndrome / gleomerulonephrosis

meningitis

ocular involvement

haematological effects

alopecia

pneumonitis

pancreatitis

myocarditits

120
Q

what is hutchinsons triad

A

interstitial keratitis

hutchinsons incisors

deafness

From congenital STS

121
Q

Major criteria in Kaufman criteria for congenital STS

A

condylomata lata

osteochondritis / periostitis

haemorrhagic rhinitis

122
Q

minor criteria in Kaufman criteria for congenital STS

A

fissures of lips

cutaenous lesions

mucous patches

hepatosplenomegally

lymphadenopathy

CNS signs

Haemolytic anaemia

Incfreased cells / protein in CSF

123
Q

other than syphilis serology what additional investigations should be carried out for suspected congenital syphilis

A

FBC

LFT

U+E

CSF

X-ray of long bones

124
Q

management of a neonate born to a mother correctly treated for STS earlier than 4 weeks before delivery

A

Infant serology at birth - NOT cord blood

if negative STS serology at birth and no symptoms = no further action needed

If +ve EIA @ birth, order RPR / TPPA / treponemal IgM EIA

serological tests detecgting IgG may be +ve due to passive maternal antibody transfer

repeat at 3, 6 and 12m

125
Q

treatment of neonatal syphilis

A

Benzyl penicillin 60 - 90 mg / kg IV daily in divided doses – 30 mg/kg 12 hourly in the first seven days of life and 8 hourly thereafter for a further 3 days for a total of 10 days

tests at 1,2,3,6,12months until negative

126
Q

what follow up is recommended after treatment of syphilis. What decline in bloods is expected

A

repeat bloods at 3, 6, 9 and 12m + additional 6monthly if req until RPR negative or serofast

RPR expected to fall at least 4x in 6months (if primary, secondary or early latent)

Late syphilis = no clear criterion, If RPR >32 at baseline, most fall a bit by 12m

127
Q

after treatment of syphilis what serology results would raise suspicion of inadequate treatment or re-infaction

A

Failure to achieve 4x drop in RPR by 6m

Failure to achieve an 8x drop in RPR by 12m

A significant increase in RPR

Persisting RPR >16 is rarely seen in correctly treated syphilis

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