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<sup>1</sup> Early latent syphilis diagnosed if during preceding yr pt had hx 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 neurosyphilis signs: Cranial nerve dysfunction, auditory/ophthalmic abnormalities, meningitis, stroke, acute or chronic altered mental status, and loss of vibration sense.
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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> Penicillin G is the only known effective tx for preventing transmission to the fetus and for fetal infxn; if penicillin allergic, desensitize and treat w/ penicillin.
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<sup>5</sup> A second dose of benzathine penicillin G 2.4 MU IM 1wk after tx may be beneficial in 1°, 2°, and early latent syphilis.
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<sup>6</sup> Sonographic signs of fetal/placental syphilis (ie, hepatomegaly, ascites, hydrops, fetal anemia, or a thickened placenta) indicate a greater risk for fetal tx failure; manage in consultation w/ OB. Evidence insufficient to recommend specific regimens for these situations.
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<sup>7</sup> Inadequate tx in the pregnant pt is likely if delivery occurs w/in 30 days of tx, clinical signs of infxn present at delivery, or Ab titer in the pregnant pt at delivery is 4-fold higher than pre-tx titer.
• 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 neurosyphilis signs: Cranial nerve dysfunction, auditory/ophthalmic abnormalities, meningitis, stroke, acute or chronic altered mental status, and loss of vibration sense.
<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> Penicillin G is the only known effective tx for preventing transmission to the fetus and for fetal infxn; if penicillin allergic, desensitize and treat w/ penicillin.
<br><br>
<sup>5</sup> A second dose of benzathine penicillin G 2.4 MU IM 1wk after tx may be beneficial in 1°, 2°, and early latent syphilis.
<br><br>
<sup>6</sup> Sonographic signs of fetal/placental syphilis (ie, hepatomegaly, ascites, hydrops, fetal anemia, or a thickened placenta) indicate a greater risk for fetal tx failure; manage in consultation w/ OB. Evidence insufficient to recommend specific regimens for these situations.
<br><br>
<sup>7</sup> Inadequate tx in the pregnant pt is likely if delivery occurs w/in 30 days of tx, clinical signs of infxn present at delivery, or Ab titer in the pregnant pt at delivery is 4-fold higher than pre-tx titer.
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If early latent syphilis,<sup>1</sup> eval mucosal surfaces (oral cavity, perianal area, perineum, vagina) for lesions. If neuro<sup>2</sup> or ocular s/sx present, eval for neurosyphilis