Divisions of Disease Control and Laboratory Services North Dakota Department of Health September 2012

Syphilis Introduction Bacterial Infection Treponema Pallidum – the syphilis sprirochete Sexually Transmitted Three clinical stages, often overlapping, and of varying severity Primary Secondary Tertiary Latent syphilis neurosyphilis

Diagnosis of Syphilis Definitive testing Darkfield microscopy of specimens from syphilitic lesions DFA or other direct observation of syphilitic spirochete by microscopy Presumptive Diagnosis –serologic testing Nontreponemal tests VDRL RPR Treponemal tests TP-PA FTA-Abs Various EIA and CIA

Presumptive Diagnosis of Syphilis A reactive nontreponemal test such as a VDRL or RPR and Positive treponemal test such as FTA-Abs or TP-PA Nontreponemal test results should be reported out quantified, such as 1:1, 1:2, 1:4, 1:8, 1:16, 1:32, 1:64, 1:128, 1:256… Nontreponemal titers may correlate with disease activity and help determine syphilis stage

Syphilis Algorithm with EIA or CIA

Testing and Screening Screening Pregnant women Anybody who is HIV positive Men who have sex with Men Anybody exchanging sex for drugs Commercial sex workers Testing Anybody who is sexually active and presents With genital lesions suggestive of syphilis With body rash where syphilis has not been ruled out With otherwise unexplained neurological deficits As sexual contacts to syphilis cases

Treatment of Syphilis Benzathine penicillin G is the drug of choice Bicillin LA® Primary, secondary and latent < 1 year duration 2.4 million units IM Late latent or syphilis of unknown duration 7.2 million units given in three doses, each 2.4 million units, IM with each dose given at 1 week intervals Failure to strictly comply will lead to retreatment Benzathine penicillin G is the only antibiotic recommended for the treatment of pregnant women Allergic - desensitize