Treatment and Prevention

Treatment

Diagnostic Test

Syphilis is most often diagnosed by standard serologic tests. Massive screening programs in the past made serologic diagnosis of syphilis very common. Mass Screening with the VDRL test is no longer practiced except in high-risk populations, pregnant women, sexually active women, and couples who are applying for a marriage license. Microscopic examination (dark filled technique) of tissue scrapings from infected lesions obtained through aspiration of regional lymph nodes also indicates the presence of the spirochete, especially during stages of syphilis (primary and secondary stages). A presumptive diagnosis is made based on suspicious lesions, positive serologic tests; know exposure to infection, and involvement of regional lymph nodes. False-positive VDRL reactions are common among persons previously treated for syphilis, but a fluorescent treponemal body (FTA) and absorption tests are more specific. Also, once a VDRL test is positive, it remains so and is not useful for identifying reinfection.

Interventions

Administering Medications

Syphilis can be successfully treated at any stage of the disease, although treatment may have to be more prolonged in latent and late syphilis. Even though syphilis can be cured in late stages, the damage to the body is much more difficult to manage.

Because to penicillin continues to be effective in the treatment of syphilis, it remains the drug of choice. All types of penicillin are effective, but penicillin G benzathine is preferred because it is long acting and can be given in a limited number of injections.

Patients with primary, secondary, and latent syphilis (and their sexual partners) are usually given 2.4 million units of penicillin intramuscularly in one dose. Patients with late syphilis are generally given 2.4 million units intramuscularly at 7-day intervals until a total of 7.2 to 9.6 million units had been given. When the use of penicillin of contraindicated due to drug sensitivity, doxycycline, 100 mg orally twice per day for 2 weeks, or tetracycline, 500 mg orally four times per day for 2 weeks, is given. For persons who cannot take tetracycline, erythromycin, 500 mg four times per day for 2 weeks, may be given. Compliance with any oral treatment regimen can be difficult, especially when the person is a chronic drug abuser and engages in other high-risk behaviors. The patient will need follow-up reminders to take the drug as prescribed.

Pregnant women with penicillin sensitivity pose problems for treatment. In the large dosage required to treat syphilis, tetracycline produces mottling and staining of fetal teeth and possible abnormal bone formation. If the woman is given the usual adult dose, inadequate placental transfer of tetracycline is likely, and congenital syphilis would probably develop. Erythromycin in a dose of 30 g over a period of 15 days seems to be the best alternative treatment for pregnant women with syphilis.

Prevention

A with gonorrhea, three levels of prevention are important. Primary prevention is prevention of the initial infection by finding and treating those with the disease so that they cannot spread it to others. Secondary prevention is directed at early treatment of cases to prevent late syphilis or congenital syphilis. Finally, as tertiary prevention, efforts can be made to treat the complications when they occur.