Nontreponemal tests, such as the rapid plasma reagin (RPR) and Venereal Disease Research Laboratory tests, detect antibody to cardiolipin, with levels rising and falling with infection and treatment over time. Given the absence of signs and symptoms in latent syphilis, diagnosis depends on syphilis testing. Sexual contacts within the prior 90 days should be found and treated with prophylactic benzathine penicillin G, and contacts within the past 12 months should be notified and tested. It is possible-and strongly recommended-to contact the county or state public health department and check if a patient with suspected latent syphilis is entered in the syphilis reactor registry, which may contain details of any prior reports on the patient.Īccording to CDC guidelines, the recommended treatment for latent syphilis of unknown duration is a weekly IM injection of benzathine penicillin G 2.4 MU for 3 weeks. Latent syphilis presents with no signs, symptoms, or sores. Although health departments have often performed such notifications in the past, some of them have been defunded or lost staff, and do not have the same resources they had 10 or 20 years ago. Medical practitioners should make a reasonable effort to notify all sexual contacts exposed in the past 90 days. 2Īny sexual contacts who may have been exposed within the past 90 days should receive prophylactic treatment with a single injection of benzathine penicillin G 2.4 MU. The efficacy of single-dose benzathine penicillin G for treatment of syphilis was reconfirmed in a study in Tanzania (more than half of participants had HIV infection), in which the proportion cured was 95% at 9 months. However, 3 injections of benzathine penicillin G 2.4 MU are recommended for individuals who have had syphilis for more than 1 year. Images A, C, and D courtesy of Joseph Engelman, MD San Francisco Department of Health.Īccording to Centers for Disease Control and Prevention (CDC) STD treatment guidelines, early syphilis of less than 1-year duration (ie, primary, secondary, or early latent syphilis) should be treated with a single intramuscular (IM) injection of benzathine penicillin G 2.4 MU, regardless of HIV serostatus. Images of primary syphilis penile chancres that could be mistaken for genital herpes or chancroid.
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