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<sup>1</sup> Early latent syphilis diagnosed if during preceding yr pt had any of:<br> • documented seroconversion or sustained (>2wk) ≥4-fold ↑ in nontreponemal titers<br>
• unequivocal s/sx of 1° or 2° syphilis<br>
• sex partner documented to have 1°, 2°, or early latent syphilis<br>
• reactive nontreponemal/treponemal tests and only possible exposure in prior 12mo
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<sup>2</sup> Examples of neuro signs: Cognitive dysfunction, motor/sensory deficits, eye/auditory sx, cranial nerve palsies, s/sx of meningitis or stroke.
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<sup>3</sup> Latent syphilis is not transmitted sexually; objective of tx is to prevent complications and vertical transmission.
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<sup>4</sup> Effectiveness of alternative tx not well documented; use only w/ close clinical/serologic f/u; ceftriaxone might be effective but dose/duration undefined.
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<sup>5</sup> Compliance likely better w/ doxycycline vs tetracycline due to GI side effects and more frequent dosing of tetracycline.
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<sup>6</sup> Jarisch-Herxheimer: Acute febrile rxn (HA, myalgia, fever, other sx) can occur w/in first 24h after the initiation of syphilis tx; most frequent among pts w/ early syphilis. Antipyretics can be used to manage sx, but not proven to prevent the rxn.
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<sup>7</sup> Although initially low titers (<1:8) might not decline.
• unequivocal s/sx of 1° or 2° syphilis<br>
• sex partner documented to have 1°, 2°, or early latent syphilis<br>
• reactive nontreponemal/treponemal tests and only possible exposure in prior 12mo
<br><br>
<sup>2</sup> Examples of neuro signs: Cognitive dysfunction, motor/sensory deficits, eye/auditory sx, cranial nerve palsies, s/sx of meningitis or stroke.
<br><br>
<sup>3</sup> Latent syphilis is not transmitted sexually; objective of tx is to prevent complications and vertical transmission.
<br><br>
<sup>4</sup> Effectiveness of alternative tx not well documented; use only w/ close clinical/serologic f/u; ceftriaxone might be effective but dose/duration undefined.
<br><br>
<sup>5</sup> Compliance likely better w/ doxycycline vs tetracycline due to GI side effects and more frequent dosing of tetracycline.
<br><br>
<sup>6</sup> Jarisch-Herxheimer: Acute febrile rxn (HA, myalgia, fever, other sx) can occur w/in first 24h after the initiation of syphilis tx; most frequent among pts w/ early syphilis. Antipyretics can be used to manage sx, but not proven to prevent the rxn.
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<sup>7</sup> Although initially low titers (<1:8) might not decline.
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If early latent syphilis,<sup>1</sup> eval mucosal surfaces (oral cavity, perianal area, perineum, vagina, beneath foreskin) for lesions. If neuro s/sx present,<sup>2</sup> eval for neurosyphilis