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Early syphilis: screen and treat to prevent transmission

Syphilis is sometimes hard to identify, and so it is important to screen and treat the sexual partners of infected persons to prevent transmission.

Syphilis is a sexually transmitted infection caused by a treponema bacterium. During the year following the onset of infection, syphilis, which is contagious, is said to be early and comprises several clinical stages: primary syphilis (development of a chancre, not always visible depending on its location); secondary syphilis (skin rash); and early latent syphilis (no clinical signs). If untreated, severe late complications occur in 10% to 30% of patients. The disease does not provide lasting immunity, and so reinfection is possible.

Confirmation of the syphilis diagnosis is generally based on serology, combining a test for treponemal antibodies, such as the ELISA test, if positive, with an additional non-treponemal serological test, such as the VDRL test.

In the absence of known resistance of treponema pallidum (syphilis) to penicillins, the first-line treatment of early syphilis is an intramuscular injection of benzathine benzylpenicillin. Doxycycline or ceftriaxone are second-choice options. The efficacy of the treatment is evaluated by a quantitative serological test such as the VDRL blood test, measured just before the start of treatment and after 3, 6 and 12 months.

It is crucial to obtain the patient’s cooperation so as to screen and treat their sexual partners.

To limit transmission, sexual intercourse, even with condoms, should be avoided for the duration of treatment.

Several factors make it difficult to prevent transmission: allergy to penicillin, difficulties in recognising the condition and in identifying potentially infected sexual partners, and the lengthy follow-up time to confirm recovery.

©Prescrire 1 March 2018

"Treatments for early syphilis" Prescrire Int 2018; 27 (191): 74-77. (Pdf, subscribers only).

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See also:

Pregnant women: continue
to screen for syphilis
(May 2010)