Syphilis latent

Primary, secondary, or latent syphilis of less than I-year s duration (early latent syphilis) Latent syphilis of more than 1-yearns duration (late latent syphilis) or syphilis of unknown duration Neurosyphilis... 

Gummas and cardiovascular Adults 2.4 million units IM once/wk for 3 wk syphilis - Latent Children 50,000 units/kg IM, up to adult dosage... 

Early latent Involves the first year after infection and maybe established in patients who have seroconverted in the past year, who have had symptoms of primary or secondary syphilis in the past year, or who have had sex with a partner with primary, secondary, or latent syphilis in the past year. 

Late latent Patients should be considered to have late latent syphilis if the aforementioned criteria (early latent) are not met. In both stages, patients are usually asymptomatic and the lesions noted in the primary and secondary phase usually resolve however, individuals are still seropositive for T. pallidum. 

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. 

Treatment modalities administered in primary syphilis are also effective in secondary syphilis and latent syphilis (less than 1 year duration). 

Order non-treponemal titers 6, 12, and 24 months after instituting treatment for early or late latent syphilis. 

Persons with a positive serologic test for syphilis but with no other evidence of disease have latent syphilis. 

Most untreated patients with latent syphilis have no further sequelae however, approximately 25% to 30% progress to either neurosyphilis or late syphilis with clinical manifestations other than neurosyphilis. 

CDC recommendations for serologic follow-up ofpatients treated for syphilis are given in Table 46-6. Quantitative nontreponemal tests should be performed at 6 and 12 months in all patients treated for primary and secondary syphilis and at 6, 12, and 24 months for early and late latent disease. 

Penicillin-allergic patients/1 primary, secondary, or early latent syphilis... 

Latent syphilis of more than 1 year s duration (late latent syphilis) or syphilis of unknown duration... 

Late (tertiary, neurosyphilis, and latent syphilis with positive spinal fluid examination or no spinal fluid examination)... 

B. The patient is pregnant and has latent syphilis of indeterminate duration. The pathogenic organism is T. pallidum. Benzathine penicillin G is the drug of first choice for treating latent syphilis. Doxycycline and tetracycline are alternatives treatments for nonpregnant patients with latent syphilis. 

Some experts recommend multiple doses of benzathine penicillin C or other supplemental antibiotics in addition to benzathine penicillin C in HIV-infected patients with primary or secondary syphilis, HIV-infected patients with early latent syphilis should be treated with the recommended regimen for latent syphilis of more than I -year s duration. 

Varicella-zoster virus is a member of the Herpesviridae femily. The viral contagion is transmitted via aerosolized water droplets or close physical contact with infected lesions. The primary infection results in varicella or chickenpox. The varicella infection can have potentially devastating ocular sequelae the most common is anterior uveitis followed by SPK. After the primary infection, latent infection occurs in multiple ganglia throughout the body. Herpes zoster is the resultant reactivation of the latent varicella-zoster virus and most often occurs in elderly and immunocompromised patients. Factors such as physical and emotional trauma, immunosuppressive medications, irradiation, cancer, tuberculosis, malaria, and syphilis are known to reactivate the virus. 

Most untreated patients with late latent syphilis have no further sequelae however, approximately 25% to 30% progress either to neurosyphilis or to late syphilis with chnical manifestations other than neurosyphilis. Treatment of aU patients with latent syphihs is essential because there is no way to predict which patients will have progression of their disease. " ... 

Therapy of syphilis with penicillin G is highly effective. Primary, secondary, and latent syphilis of <1 year s duration may be treated with penicillin G procaine (2.4 million units per day intramuscularly), plus probenecid (1.0 g/day orally) to prolong the tj for 10 days or with 1—3 weekly intramuscular doses of 2.4 million units of penicillin G benzathine (three doses in patients with HIV infection). Patients with neurosyphilis or cardiovascular syphilis typically receive intensive therapy with 20 million units of penicillin G daily for 10 days. Since there are no proven alternatives for treating syphilis in pregnant women, penicillin-allergic individuals must be acutely desensitized to prevent anaphylaxis. 

Immunologic In 115 patients with syphilis, 26 with latent disease, 37 with primary syphilis, 51 with secondary syphilis, and 1 with tertiary syphilis, who were given benzathine penicillin, 10 (8.7%) developed Jarisch-Herxheimer reactions [44 ]. All the reactions occurred in those with secondary and latent syphilis. None had an allergic reaction. 

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