Syphilis diagnosis

Note CF may produce false-positive reactions in those exposed to leishmaniasis, syphilis, and malaria. PCR may be more definitive for diagnosis.)... 

Syphilis, caused by the spirochete Treponema pallidum, can have numerous and complex manifestations. Clinician familiarity, stage-specific diagnosis, and effective treatment are vital. Missed or inappropriately treated syphilis may result in cardiovascular complications, neurologic disease, or congenital syphilis. 

After confirming the diagnosis of syphilis, the desired outcome is a four-fold decrease in quantitative non-treponemal titers over a 6-month period and within 12 to 24 months after treatment of latent or late syphilis. An algorithm for the treatment of syphilis is shown in Fig. 77-1. 

Brown D, Frank J. Diagnosis and Management of Syphilis. American Family Physician. 2003 68(2) 283-290. 

Suggested Alternatives for Differential Diagnosis Anthrax, brucellosis, dengue, ehrlichiosis, infectious mononucleosis, Kawasaki disease, leptospirosis, malaria, meningitis, men-ingococcemia, relapsing fever, Rocky Mountain spotted fever, syphilis, toxic shock syndrome, toxoplasmosis, tularemia, typhoid fever, rubella, measles. 

Serologic tests are the mainstay in the diagnosis of syphilis and are categorized as nontreponemal or treponemal. Commonly used nontrep-onemal tests include the Venereal Disease Research Laboratory shde test, the rapid plasma reagin card test, the unheated serum regain test, and the toluidine red unheated serum test. 

The spectrum of sexually transmitted diseases (STDs) includes the classic venereal diseases—gonorrhea, syphilis, chancroid, lymphogranuloma venereum, and granuloma inguinale—as well as a variety of other pathogens known to he spread hy sexual contact (Table 46-1). Common clinical syndromes associated with STDs are listed in Table 46-2. The most current information on epidemiology, diagnosis, and treatment of STDs provided by the Centers for Disease Control and Prevention (CDC) can be found at http //www.cdc.gov. 

The diagnosis of herpes simplex disciform keratitis is usually based on clinical appearance. If a history of previous episodes, ghost scars, or decreased corneal sensation is found, herpes simplex is the likely cause, but it is important to rule out other etiologies such as herpes zoster, varicella, vaccinia, mumps, and syphilis. 

Posterior uveitis is rarely a stand-alone diagnosis. Rather, this term is typically used to describe the manifestations of numerous inflammatory conditions involving the choroid and/or retina. The more common etiologies of posterior uveitis include toxoplasmosis, sarcoidosis, syphilis, histoplasmosis, and retinal white-dot syndromes. These conditions may affect a wide range of individuals with regard to age, gender, race, and national origin. 

Wicher K, Horowitz HW, Wicher V. Laboratory methods of diagnosis of syphilis for the beginning of the third millennium. Microbes Infect 1999 1 1035-1049. 

Syphilis. Several reports have appeared in recent years concerning the development of hepatitis as a complication of secondary syphilis (B3, C3, L8). A clue to the diagnosis of syphilitic hepatitis is the disproportionate increase which occurs in the serum alkaline phosphatase level values as high as 15 times the upper reference limit have been observed (L8). The abnormalities in liver function regress after standard therapy for syphilis, although serum alkaline phosphatase may take some weeks to return to normal (C3). 

Spectinomycin is not effective in the treatment of syphilis. Antibiotics used to treat gonorrhea may mask or delay the symptoms of incubating syphilis. All patients with gonorrhea should have a serologic test for syphilis at the time of diagnosis and a follow-up test after 3 months. 

Which is the preferred treatment for the diagnosis of primary syphilis in a teenage client ... 

Kahn, R.L., 1928. Serum diagnosis for syphilis. In Alexander, J. (Ed.), Colloid Chemistry. 

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