Treponema pallidum pallidum - Revision history

Aidan: /* Management */

2026-01-19T18:43:42Z

Management

← Older revision		Revision as of 18:43, 19 January 2026
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	\|Neurosyphilis		\|Neurosyphilis
	\|[[penicillin G]] 4 MU IV q4h for 10-14 days		\|[[penicillin G]] 4 MU IV q4h for 10-14 days
			± an IM dose as follow-on, as above
	\|desensitization		\|desensitization
	[[ceftriaxone]] 2 g IV/IM q24h for 10-14 days		[[ceftriaxone]] 2 g IV/IM q24h for 10-14 days

Aidan: /* Secondary Syphilis */

2026-01-19T18:39:27Z

Secondary Syphilis

← Older revision		Revision as of 18:39, 19 January 2026
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	**Typically begins on trunk		**Typically begins on trunk
	**Start as pinkish-reddish macular lesions that evolve into brownish-reddish papules that may have scaling		**Start as pinkish-reddish macular lesions that evolve into brownish-reddish papules that may have scaling
	**May progress to pustular lesions (pustular ~~syphilids~~)		**May progress to pustular lesions (pustular syphilis)
	**May be itchy		**May be itchy
	**Can be isolated to [[Rashes involving palms and soles\|palms and soles]]		**Can be isolated to [[Rashes involving palms and soles\|palms and soles]]

Aidan: /* Lumbar Puncture for CSF */

2025-08-20T14:51:25Z

Lumbar Puncture for CSF

← Older revision		Revision as of 14:51, 20 August 2025
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	**RPR is specific but less sensitive; it helps to rule in CNS disease when present		**RPR is specific but less sensitive; it helps to rule in CNS disease when present
	**FTA-Abs is sensitive but less specific; it help to rule out CNS disease when absent		**FTA-Abs is sensitive but less specific; it help to rule out CNS disease when absent
			*Intepretation[[CiteRef::wong2015ca]]
			**VDRL positive: treat
			**VDRL negative
			***Protein <= 0.45: ruled out
			***Protein > 0.45
			****FTA-ABS positive: treat
			****FTA-ABS negative: ruled out (though may still have ophthalmic or auditory involvement)

	==Management==		==Management==

Aidan: /* Lumbar Puncture for CSF */

2024-12-25T21:57:41Z

Lumbar Puncture for CSF

← Older revision		Revision as of 21:57, 25 December 2024
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	===Lumbar Puncture for CSF===		===Lumbar Puncture for CSF===

	*Should be done routinely when:		*Should be done routinely when:[[CiteRef::wudel2024ca]]
	**Neurological ~~(including optic and auditory)~~ signs or symptoms		**Neurological signs or symptoms
			***Excluding isolated ocular or auditory symptoms, which usually has normal CSF but is still treated like neurosyphilis
	**Failure of serologic response		**Failure of serologic response
			**Serofast with persistently high RPR >1:32
	**Tertiary syphilis		**Tertiary syphilis
	**Congenital syphilis		**Congenital syphilis
	**In patients with HIV: CD4 ≤350 ~~and~~ RPR ≥1:32		**Can be considered in asymptomatic patients with HIV who have CD4 ≤350 or RPR ≥1:32
	*The sample should be sent for cell count and differential, protein, and either VDRL (not RPR) or FTA-Abs		*The sample should be sent for cell count and differential, protein, and either VDRL (not RPR) or FTA-Abs
	**RPR is specific but less sensitive; it helps to rule in CNS disease when present		**RPR is specific but less sensitive; it helps to rule in CNS disease when present

Aidan at 13:35, 2 July 2024

2024-07-02T13:35:05Z

← Older revision		Revision as of 13:35, 2 July 2024
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	===Other Presentations===		===Other Presentations===

			*Otosyphilis
	*Isolated auditory syphilis
			*[[eye:Ophthalmologic Manifestations of Syphilis\|Ocular syphilis]], including [[eye:Syphilitic Uveitis\|uveitis]]: blurry vision, floaters, light sensitivity, double vision, eye pain, and foreign body sensation
	*Isolated optic syphilis
	*Syphilitic osteitis and osteomyelitis, which can present in any stage		*Syphilitic osteitis and osteomyelitis, which can present in any stage

Aidan at 10:58, 5 March 2024

2024-03-05T10:58:01Z

← Older revision		Revision as of 10:58, 5 March 2024
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	*Isolated auditory syphilis		*Isolated auditory syphilis
	*Isolated optic syphilis		*Isolated optic syphilis
			*Syphilitic osteitis and osteomyelitis, which can present in any stage

	===Congenital Syphilis===		===Congenital Syphilis===

Aidan at 14:32, 12 November 2023

2023-11-12T14:32:37Z

← Older revision		Revision as of 14:32, 12 November 2023
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	**May be itchy		**May be itchy
	**Can be isolated to [[Rashes involving palms and soles\|palms and soles]]		**Can be isolated to [[Rashes involving palms and soles\|palms and soles]]
	*Generalized lymphadenopathy		*Generalized [[lymphadenopathy]]
	*Fever, chills, arthralgias		*Fever, chills, arthralgias
	*Less common: condyloma lata, aseptic meningitis, iritis, mucosal white patches, glomerulonephritis, paroxysmal nocturnal hemoglobinuria, hepatitis		*Less common: [[condyloma lata]], [[aseptic meningitis]], [[iritis]], mucosal white patches, [[glomerulonephritis]], [[paroxysmal nocturnal hemoglobinuria]], [[hepatitis]]
			*This is the most common time to develop ocular involvement, including:
			**[[Anterior uveitis]] (usually unilateral though can become bilateral)
			**Posterior involvement with [[vitritis]], [[necrotizing retinitis]], [[chorioretinitis]], [[retinal vasculitis]], and [[optic neuritis]] (usually toward the end of secondary syphilis)
			***[[Chorioretinitis]] is the most common
			**Acute posterior placoid chorioretinopathy (in secondary or late latent syphilis)

	===Latent Syphilis===		===Latent Syphilis===

Aidan: /* Neurosyphilis */

2023-11-12T14:18:31Z

Neurosyphilis

← Older revision		Revision as of 14:18, 12 November 2023
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	*Of the 25-60% of people who have CNS invasion, 95% are asymptomatic during the early stage and 80% of those spontaneously clear it		*Of the 25-60% of people who have CNS invasion, 95% are asymptomatic during the early stage and 80% of those spontaneously clear it
	*Incubation period is 7-15 years		*Incubation period is 7-15 years
	*Three major presentations: meningovascular syphilis, parenchymous syphilis, and ~~tabse~~ dorsalis		*Three major presentations: meningovascular syphilis, parenchymous syphilis, and tabes dorsalis

	=====Meningovascular=====		=====Meningovascular=====

Aidan at 17:17, 2 November 2022

2022-11-02T17:17:11Z

← Older revision		Revision as of 17:17, 2 November 2022
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	\|}		\|}

	===Primary, Secondary, and Early Latent===		=== Primary, Secondary, and Early Latent ===

	*[[Is treated by::Benzathine penicillin G]] 2.4 million units IM once, divided between two buttocks		*[[Is treated by::Benzathine penicillin G]] 2.4 million units IM once, divided between two buttocks
	*Alternative (penicillin allergy): [[Is treated by::doxycycline]] 100mg BID for 2 weeks		*Alternative (penicillin allergy): [[Is treated by::doxycycline]] 100mg BID for 2 weeks
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	*If ≥1 month of age: [[Is treated by::crystalline penicillin G]] 50,000 units/kg IV every 6 hours for 10-14 days		*If ≥1 month of age: [[Is treated by::crystalline penicillin G]] 50,000 units/kg IV every 6 hours for 10-14 days
	**If there is no neurological involvement, then you can consider [[Is treated by::benzathine penicillin G]] 50 kU/kg (max 2.4 MU) IM weekly for 3 weeks		**If there is no neurological involvement, then you can consider [[Is treated by::benzathine penicillin G]] 50 kU/kg (max 2.4 MU) IM weekly for 3 weeks

			=== Follow-Up RPR ===

			* RPR should be trended after treatment to ensure response, and repeated until negative (or stably low titre)
			* It should be remeasured on the day of treatment, as it will often change significantly from diagnosis, even if it has only been a few days

	==Prevention==		==Prevention==

Aidan: /* Tertiary Neurosyphilis */

2021-12-22T01:17:04Z

Tertiary Neurosyphilis

← Older revision		Revision as of 01:17, 22 December 2021
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	*[[Is treated by::Penicillin G]] 4 million units IV q4h for 10 to 14 days		*[[Is treated by::Penicillin G]] 4 million units IV q4h for 10 to 14 days
	*Often followed by at least one dose of IM benzathine penicillin, sometimes weekly for 2-3 weeks		*Often followed by at least one dose of IM benzathine penicillin, sometimes weekly for 2-3 weeks
	*~~Alternative~~ is [[doxycycline]] 100 mg p.o. BID for 28 days~~, which~~ may be noninferior[[CiteRef::girometti2021cl]]		*For early neurosyphilis, the alternative of [[doxycycline]] 100 mg p.o. BID for 28 days may be noninferior[[CiteRef::girometti2021cl]]
	*Monitor serologic response with RPR titres at 6, 12, and 24 months, and until negative or stable low titre		*Monitor serologic response with RPR titres at 6, 12, and 24 months, and until negative or stable low titre
	*Repeat lumbar puncture every 6 months until parameters normalize		*Repeat lumbar puncture every 6 months until parameters normalize