Clinical Guidelines Syphilis - Michigan



Syphilis (Treponema pallidum)INTRODUCTION: Syphilis is a systemic sexually transmitted disease caused by Treponema pallidum. The disease has been divided into a series of overlapping stages. Primary infectionSecondary infection Tertiary infection Latent infectionEarly latent- syphilis acquired within the preceding yearLate latent- unknown duration of diseaseSUBJECTIVE DATA: History may include:History of SyphilisRecent change in sexual partnerPartner with symptoms of or infection with SyphilisLack of STD protection (condom use)Reports multiple sexual partners &/or partner has multiple partnersReports symptoms of Syphilis infection (i.e., chancre, rash)Reports engaging in commercial sex work and drug useIII.OBJECTIVE DATA:Physical exam findings: Primary-painless indurated ulcer or chancre at the infection siteSecondary- skin rash, mucocutaneous lesions, lymphadenopathy, neurologic infection, cranial nerve dysfunction, meningitis, stroke, acute or chronic altered mental status, loss of vibration sense, and auditory or ophthalmic abnormalitiesTertiary- cardiac, gummatous lesionsLatent –No evidence of diseaseASSESSMENT:Diagnosis is made by:Dark-field examinationVDRL and RPR FTA-ABS tests, TP-PA assay, various EIAs, and chemiluminescence immunoassay. The use of only one type of serologic test is insufficient for diagnosis, because each type of test has limitations, including the possibility of false-positive test results in persons without syphilis. False-positive nontreponemal test results can be associated with various medical conditions unrelated to syphilis, including autoimmune conditions, older age, and injection-drug use; therefore, persons with a reactive nontreponemal test should receive a treponemal test to confirm the diagnosis of syphilis.PLAN Family Planning Clinics are recommended to consult with the Medical Director and /or Communicable Disease Director to collaboratively diagnose, treat, and care for clients with syphilisRecommended Regimen for AdultsBenzathine penicillin G is the preferred drug for treating all stages of syphilis.See Current CDC Guidelines at CDC STD Treatment Guidelines PDFThe preparation used, the dosage, and the length of treatment depends on the stage and clinical manifestations of the disease.Vl.SPECIAL CONSIDERATIONS: Pregnancy: Refer to their prenatal providerHIV-immuno suppressed clients: Refer to care coordinatorVII.CLIENT EDUCATION: Sexual partner and any sexual contacts in the last 90 days (preceding onset of symptoms or diagnosis) must be informed of possible infection and provided written materials about the importance of seeking evaluation for any symptoms suggestive of complications (i.e., skin rash, chancre , lymph adenopathy etc. Screening and treatment of sex partners is essential for decreasing the risk for re-infection. Provide Medication Information SheetProvide STD education and informationOffer other STD testingProvide current educational information on T. pallidum Provide contraceptive information, if indicated Encourage consistent and correct condom use to prevent STDs Educate partners, if possible, about symptoms and to encourage partners to seek clinical evaluation FOLLOW-UP: Clinical and serologic evaluation should be performed at 6 and 12 months after treatment.Clients who have symptoms that persist or recur after treatment should be evaluated and retested.HIV status should be evaluate.REFERRAL: Pregnant clients – (refer to prenatal care)Referral must be made if treatment management is not provided in your clinic.REPORTINGSyphilis infection is a reportable disease in Michigan. Reports should be made to your local health department without delay.References: CDC: Sexually Transmitted Disease Treatment Guidelines, 2015Reportable Diseases in Michigan: A Guide for Physicians, Health Care Providers and Laboratories 2015Reviewed/Revised: 2017 ................
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