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<sup>1</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>2</sup> Latent syphilis is not transmitted sexually; objective of tx is to prevent complications and vertical transmission.
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<sup>3</sup> If pt misses a dose of penicillin in a course of weekly tx, appropriate course of action unclear. Interval of 10–14 days between doses might be acceptable before restarting the sequence of injections (ie, if dose 1 is given on day 0, dose 2 is administered between days 10 and 14). Pharmacologic considerations suggest that an interval of 7–9 days between doses, if feasible, might be more optimal.
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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.
<sup>2</sup> Latent syphilis is not transmitted sexually; objective of tx is to prevent complications and vertical transmission.
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<sup>3</sup> If pt misses a dose of penicillin in a course of weekly tx, appropriate course of action unclear. Interval of 10–14 days between doses might be acceptable before restarting the sequence of injections (ie, if dose 1 is given on day 0, dose 2 is administered between days 10 and 14). Pharmacologic considerations suggest that an interval of 7–9 days between doses, if feasible, might be more optimal.
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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.
<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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Eval mucosal surfaces (oral cavity, perianal area, perineum, vagina, beneath foreskin) for lesions. If neuro s/sx present,<sup>1</sup> eval for neurosyphilis