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Individual primers on more than 100 skin diseases including initial evaluation, treatment options, and clinical case studies. The treatment of syphilis is based on the duration of infection and the organ systems involved. When a diagnosis of syphilis is made, evaluation for other STDs and treatment of potentially infected contacts are necessary. Syphilis is caused by infection by the bacterial spirochete, Treponema pallidum, which is sexually and vertically transmitted. For all patients with neurosyphilis, and infants with possible neurosyphilis, in addition, a CSF examination must be repeated 6 months following treatment. Diagnosis can be made on the basis of clinical findings, darkfield examination, nontreponemal tests (RPR or VDRL), treponemal serologies (FTA-Abs or MHA-TP).
When neurosyphilis is suspected, CSF should be examined for increased cell count, increased protein content, a positive CSF VDRL, and serum FTA-ABS or MHA-TP (both are usually positive in all cases).
First-line therapy: The first-line therapy for syphilis depends on the duration of infection and the immune competence of the host. A single 2 g dose of azithromycin may be considered as a second choice treatment; azithromycin-resistant strains are common.
Tetracycline is contraindicated in the second and third trimesters of pregnancy and in children less than 8 years of age.
A Jarisch-Herxheimer reaction may occur in the first 24 hours after treating any patient, resulting from inflammatory cytokines triggered by antigens elaborated by dying spirochetes.


The ulcer fluid reveals presence of spirochetes by darkfield microscopy and the RPR and VDRL are also both elevated. A detailed sexual history is performed and his case (and contacts) are reported to the public health department. Follow-up evaluation in two weeks (ulcer healed) and he is also referred to primary care physician for ongoing management of his HIV disease. Read PJ and Donovan B (2012) Clinical aspects of adult syphilis, Int Med Journal, 42: 614-619. Roett MA, Mayor MT, Uduhiri KA (2012) Diagnosis and management of genital ulcers, AFP, 85: 255-262. DISCLAIMER: Use of this Website constitutes acceptance of the Derm101 terms of use and privacy policy. Adequate treatment of the mother before delivery, except with erythromycin, treats the infant, although if treatment is delayed until late in gestation, stigmata may still appear.
A CSF examination should precede and guide treatment of HIV-infected individuals with latent syphilis or syphilis present for 1 year or more, or of unknown duration. The patient is followed clinically and serologically three months later and every three months following for the first year, and then one year afterwards.
This site is intended for use by physicians and other healthcare providers for informational purposes only. It presents across a broad clinical spectrum, including many cutaneous signs, that evolves with the duration of the infection and also correlates with the immune status of the patient.


Diagnosis requires a reactive CSF with increased cell count, increased protein content, and a positive CSF VDRL. In all cases of syphilis it is important to examine for and treat other STDs, and to trace and treat all contacts. If oral therapy is given, compliance must be stressed, and careful follow-up is essential to document cure.
Over this monitoring period, his serologic titers were reduced to undetectable levels and he exhibited no additional signs of syphilis infection.
The content of this Website is NOT a substitute for medical advice from a qualified health care provider. CSF examination in documented neurosyphilis (with abnormal CSF findings) is continued at 6-month intervals for 2 years. Infected individuals may resume sexual activity after skin lesions, if present, are healed, or after therapy is complete.



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  • barawka, 11.02.2014 at 13:50:57
    And the way it eludes treatment that it might disable.
  • arkadas, 11.02.2014 at 15:51:17
    Have got the blisters or sores his e mail.