COLLABORATIVE

Medical treatment for syphilis infection at any stage consists of antibiotic therapy to destroy the infecting bacteria. After treatment, patients are instructed to refrain from sexual contact for at least 2 weeks or until lesions heal, and to return for serology testing in 1 month and then every 3 months for 1 year.

Carefully question patients about penicillin sensitivity before treatment. They should also be warned about the Jarisch-Herxheimer reaction, which is believed to be caused by toxins that are released from dying spirochetes. The reaction develops 6 to 12 hours after the initial penicillin dose and causes fever, headache, nausea, tachycardia, and hypotension. Instruct the patient to rest, drink fluids, and take antipyretics.

Tell the patient that the disease must be reported to the local health authority and that confidentiality will be maintained. Identifying and treating sexual partners of the infected patient is an important intervention. If the patient is treated in the primary or secondary stage, attempt to contact all sexual partners from the past 3 months. If the patient is in the later stages of the disease, contacts from the previous year are screened. Handle the "contact discovery" interview carefully, and if possible, have a public health professional conduct the interview.

Pharmacologic Highlights

Medication or Drug Class	Dosage	Description	Rationale
Benzathine penicillin G	2.4 million units IM, single dose (some recommend a second dose 1 wk later)	Antibiotic, penicillin	Effective for primary, secondary, and latent syphilis of less than 1-yr duration
Benzathine penicillin G	2.4 million units, IM, weekly, for 3 doses	Antibiotic, penicillin	Effective treatment for latent syphilis of more than 1-yr duration or cardiovascular or late benign syphilis
Aqueous crystalline penicillin G	2–4 million units IV q 4 hr for 10–14 days	Antibiotic, penicillin	Recommended to treat neurosyphilis

Other antibiotics: Doxycycline, azithromycin.

INDEPENDENT

Provide care for the patient's lesions. Keep them clean and dry. Properly dispose of contaminated materials from draining lesions. Use universal precautions when you come in direct contact with the patient, when collecting specimens, and when caring for the lesions.

Focus on prevention. Educate patients about the course of the disease and the need to return for follow-up treatment or blood tests. Patients need to understand that although their lesions may heal, the infection may not be gone. Approximately 10% of patients do not respond to the first round of antibiotics, so additional treatment may be necessary.

Teach patients how to reduce risk factors to prevent future infections by limiting the number of sexual partners and practicing safer sex. Using condoms with spermicide and inspecting partners for any rashes or lesions may reduce exposure to the disease. Patients need ongoing emotional support to make lifestyle changes. Explain the need for regular laboratory testing (VDRL) every 3 months for 2 years to detect a relapse. Urge patients in the latent or late stages to have blood tests every 6 months for 2 years. Explain the relationship between HIV and syphilis and perform HIV testing if the patient wishes.