Clinical Manual for Management of the HIV-Infected ... - myCME.com

Some patients retain reactive (low-titer) nontreponemal
test results after successful treatment for syphilis. In
these “serofast” individuals, reinfection with syphilis is
indicated by a rise in test titer of at least 4-fold.
Risk-reduction counseling
All patients with syphilis should receive risk evaluation
and risk-reduction counseling. Evaluate each patient’s
sexual practices with regard to risk of acquiring STIs
and of transmitting HIV. Work with the patient to
reduce sexual risks.
Patient Education
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Instruct patients to go to clinic for treatment at the
intervals recommended. If patients are given oral
antibiotics (penicillin-allergic individuals), instruct
them to take their medications exactly as prescribed.
Warn patients about the possibility of Jarisch-
Herxheimer reaction and advise them about
self-management of associated symptoms (eg,
acetaminophen or aspirin at usual doses, fluids, and
rest).
Instruct patients about the required follow-up
laboratory and clinical evaluations necessary to
document adequate treatment. Emphasize the need
for regular evaluation of treatment efficacy.
Sexual partners from the previous 3-6 months
(sometimes longer, depending on the stage of
syphilis) need to be evaluated and treated as soon
as possible, even if they have no symptoms. Advise
patients to inform their partner(s) that they need to
be tested and treated.
Syphilis is a reportable communicable disease in
the United States. Patients will be contacted to
assist with partner tracing and to ensure appropriate
treatment.
Provide education about sexual risk reduction.
Review sexual practices and support patients in
using condoms with every sexual contact to prevent
becoming reinfected with syphilis or infected with
other STIs, and to prevent passing HIV to sexual
partners.
References
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Section 6—Disease-Specific Treatment | 6–103
Centers for Disease Control and Prevention.
Sexually transmitted diseases treatment guidelines 2006.
MMWR 2006;55(No. RR-11):1-100.
Centers for Disease Control and Prevention. Trends
in primary and secondary syphilis and HIV infections
in men who have sex with men—San Francisco and
Los Angeles, California, 1998–2002. MMWR Morb
Mortal Wkly Rep. 2004 Jul 9;53(26):575-8.
Centers for Disease Control and Prevention,
National Institutes of Health, HIV Medicine
Association/Infectious Diseases Society of America.
Treating Opportunistic Infections Among HIV-Infected
Adults and Adolescents. December 17, 2004. Accessed
April 14, 2006.
Colven R, Spach DH. Generalized Cutaneous
Manifestations of STD/HIV Infection. In: Holmes
KK, Mardh PA, Sparling PF, et al, eds. Sexually
Transmitted Diseases, 3rd Edition. New York:
McGraw-Hill; 1999:875-876.
Mitchell SJ, Engelman J, Kent CK, et al.
Azithromycin-resistant syphilis infection: San Francisco,
California, 2000-2004. Clin Infect Dis. 2006 Feb
1;42(3):337-45.
Musher DM. Early Syphilis. In: Holmes KK, Mardh
PA, Sparling PF, et al, eds. Sexually Transmitted
Diseases, 3rd Edition. New York: McGraw-Hill;
1999:48.