Tx syphilis

Question 1

DOC of all stages

Answer 1

Penicillin

Question 2

not recom for tx of any stage or form of syphilis

Answer 2

Erythromycin

Question 3

testing this is recomm in all pxs w syphy

Answer 3

HIV testing

Question 4

1,2 or early latent sy known to be of less than 1 yr in durstion can be tx w

Answer 4

Single IM injection of 2.4 million units (megaunits MU) lf benzarhine penicilline G.

Question 5

in non pregnant, penicillin allergic HIV negative pxs

Answer 5

tetracycline 500mg orally 4x a day or

Doxycycline 100 mg orally twice a day for 2 weeks.

Question 6

if px cannot tolerate prev options- alternative

Answer 6

Ceftriaxone 1g IM or IV FOR 8-10 days.

azithromycin and erythro not recomm for sy bec of worldwide presence of macrolide resistance.

Question 7

tx late or late latent sy of more than 1 yr duration in an HIV negative px.

Answer 7

Benzathine pen G 2.4 MU IM once weekly for 3 weeks.

Question 8

in penicillin allergic non preg HIV neg px.

Answer 8

Doxycycline 100 mg twice a say for 14 days. (28 days for latent sy)

Question 9

tx neurosyphylis

Answer 9

Pencillin G crystalline 3-4 MU IV every 4 hours for 10-14 days
or
Procaine penicillin 2.4 Mu/day IM plus probenecid 500 mg orally 4x a day both for 10-14 days.

may be ff by benzathine penicillin G 2.4MU Im once weekly for 3 weeks.

Question 10

tx congenital sy

Answer 10

CSF EVAL.
and may be tx w
aqueous crystalline pen G 200,000-300,000 U/kg/day IV or IM(50,000 U every 4-6 hours) for 10-14 days.

Question 11

pregnant women w syphilis

Answer 11

penicillin in doses app for the stage of sy. second dose of benzarhine pen 2.4 MU IM may be administered 1 week after initial dose in preg women w primary secondary or early latent sy.

sonographic eval of ferus in second half of pregnancy

Question 12

after initial dose of anti syphilitic tx spec penicillin

Answer 12

Jarisch- Herxheimer or Herxheimer reaction

occurs 6-8 hrs after tx. shaking chils fever malaise sore throat myalgia headache tachycardia and exacerbatuon of inflamm rxn at sites of localized spirochetal infection.

Question 13

tx for sexual partners

Answer 13

within 90 days
serologic titer > 1:32

Benzathine penicillin 2.4 Mu IM one dose

Question 14

clinical and serologic eval performed when

Answer 14

6 and 12 mos after tx.

retreatment regimen: Benzathine Pen G 2.4 MU weekly for 3 weeks.

Question 15

HIV infection who have primary or secondary su not allergiv to pen no neuro and psych findings tx

Answer 15

Benzathine G 2.4 MU IM

ff up: 3,6,912,24 months.

also dor all HIV infected contacts of patients w syphilis who are ay risk of acquiring infection