Clinical Guidelines Syphilis

Syphilis (Treponema pallidum)

I.INTRODUCTION

Syphilis is a systemic sexually transmitteddisease caused by Treponema pallidum. The disease has been divided into a series of overlapping stages.

• Primary infection
• Secondary infection
• Tertiary infection
• Latent infection
• Early latent- syphilis acquired within the preceding year
• Late latent- > 1 year or unknown duration of disease

II.SUBJECTIVE DATA

History may include:

• History of Syphilis
• Recent change in sexual partner
• Partner with symptoms of or infection with Syphilis
• Lack of STD protection (condom use)
• Reports multiple sexual partners&/or partner has multiple partners
• Reports symptoms of Syphilis infection (i.e., chancre,rash)
• Reports engaging in commercial sex work and drug use

III.OBJECTIVE DATA

Physical exam findings:

• Primary-painless indurated ulcer or chancre at the infection site
• Secondary- skin rash, mucocutaneous lesions, lymphadenopathy, neurologic infection, cranial nerve dysfunction, meningitis, stroke, acute or chronic altered mental status, loss of vibration sense, and auditory or ophthalmic abnormalities
• Tertiary-findings dependent on location of lesions – in heart, brain, nerves, eyes, blood vessels, liver, bones.
• Latent –No physical evidence of disease

1. ASSESSMENT

Diagnosis is confirmed by:

• Dark-field examination of exudates.

• Non-treponemal tests: VDRL and RPR
• Treponemal tests: FTA-ABS tests, TP-PA assay, various EIAs, and chemiluminescence immunoassay.

The use of only one type of serologic test is insufficient for diagnosis, because each type of test has limitations, including the possibility of false-positive test results in persons without syphilis. False-positive nontreponemal test results can be associated with various medical conditions unrelated to syphilis, including autoimmune conditions, older age, and injection-drug use; therefore, persons with a reactive nontreponemal test should receive a treponemal test to confirm the diagnosis of syphilis.

1. PLAN

• Family Planning Clinics are recommended to consult with the Medical Director and /or Communicable Disease Director to collaboratively diagnose, treat, and care for clients with syphilis

• See Current CDC Guidelines at

• The preparation used, the dosage, and the length of treatment dependson the stage and clinical manifestations of the disease.

Vl.SPECIAL CONSIDERATIONS

• Pregnancy: Refer to their prenatal provider
• HIV-immuno suppressed clients: Refer to care coordinator

VII.CLIENT EDUCATION

• Sexual partner and any sexual contacts in the last 90 days (precedingonset of symptoms or diagnosis) must be informed of possible infection and provided written materials about the importance of seeking evaluation for any symptoms suggestive of complications (i.e., skin rash, chancre , lymph adenopathy etc.
• Screening and treatment of sex partners is essential for decreasing the risk for re-infection.
• Provide Medication Information Sheet
• Provide STDeducation and information
• Offer other STD testing
• Provide current educational information on T. pallidum
• Provide contraceptive information, if indicated
• Encourage consistent and correct condom use to prevent STDs
• Educate partners, if possible, about symptoms and to encourage partners to seek clinical evaluation

1. FOLLOW-UP

• Clinical and serologic evaluation should be performed at 6 and 12 months after treatment.
• Clients who have symptoms that persist or recur after treatment should be evaluated and retested.
• HIV status should be evaluated.

1. REFERRAL

• Pregnant clients – (refer to prenatal care)
• Referral must be made if treatment management is not provided in your clinic.

1. REPORTING

• Syphilis infection is a reportable disease in Michigan. Reports should be made to your local health department without delay.

References:

1. CDC: Sexually Transmitted Disease Treatment Guidelines, 2015
2. Reportable Diseases in Michigan: A Guide for Physicians, Health Care Providers and Laboratories2017

Reviewed/Revised: 2018

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