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Syphilis plan

﻿‍Penicillin G 2,4 M units im x 1﻿ 
﻿‍Jarisch-Herxheimer reaction discussed﻿  acute febrile illness 2 to 24 hrs after penicillin  
﻿‍Repeat RPR in 3, 6 and 12 months ﻿ 
﻿‍Test all partners < 1 year﻿ 
﻿‍No sexual activity until 7 days after penicillin and asymptomatic, then safe sex.﻿ 
﻿‍Notice to appropriate authority﻿ 
﻿‍Infectious disease referral﻿  if late latent (>1 year) or unknown latent stage
﻿‍Lumbar puncture﻿ if neurosyphilis suspected
﻿
Post-Tx follow-up: RPR at 12 months
 Primary: RPR at 12 months should decrease by 3 dilutions (e.g. 1:32 → 1:4)
 Secondary: RPR at 12 months should decrease 4 dilutions
 Early latent: RPR at 12 months should decrease by 2 diluations
 Expect titer ≤ 1:4 and stable

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