Syphilis: management

Syphilis: management

• intramuscular benzathine penicillin is the first-line management
  Syphilis: intramuscular benzathine penicillin is first-line
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  Importance: 67
• alternatives: doxycycline
• nontreponemal (rapid plasma reagin [RPR] or Venereal Disease Research Laboratory [VDRL]) titres should be monitored after treatment to assess the response
  nontreponemal (rapid plasma reagin [RPR] or Venereal Disease Research Laboratory [VDRL]) titres should be monitored after treatment to assess the response
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  • a fourfold decline in titres (e.g. 1:16 → 1:4 or 1:32 → 1:8)is often considered an adequate response to treatment
• the Jarisch-Herxheimer reaction is sometimes seen following treatment
  • fever, rash, tachycardia after the first dose of antibiotic
    Jarisch-Herxheimer reaction: Fever, rash, chills and headache occurs following antibiotic administration for syphilis
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    Importance: 94
  • in contrast to anaphylaxis, there is no wheeze or hypotension
    The Jarisch-Herxheimer reaction, unlike an anaphylactic reaction, will not present with hypotension and wheeze
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    Importance: 92
  • it is thought to be due to the release of endotoxins following bacterial death and typically occurs within a few hours of treatment
  • no treatment is needed
    The Jarisch-Herxheimer reaction is a known phenomenon following syphilis treatment that does not require any specific treatment or investigations other antipyretics
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    Importance: 61
    other than antipyretics if required