Synopsis
Recognise stage-specific and neurological syphilis, interpret treponemal and non-treponemal tests together, deliver penicillin-based therapy and confirm serological response with partner management.
- Primary syphilis usually causes a painless indurated ulcer with regional lymphadenopathy, but chancres can be painful, multiple or hidden.
- Secondary syphilis causes a generalized rash often involving palms and soles, mucous patches, condylomata lata, lymphadenopathy and systemic symptoms.
- Latent syphilis has reactive serology without clinical signs; timing determines whether early or late-latent treatment is needed.
Key red flags
Any visual symptom with reactive syphilis serology is ocular syphilis until urgent ophthalmic assessment proves otherwise.
Meningitis, cranial neuropathy, ocular inflammation, hearing disturbance or meningovascular stroke may occur during early infection.
Investigation priorities
Detect antibodies indicating present or previous T pallidum infection.
Management branches
Screening serology, a compatible lesion, rash or partner notification raises syphilis probability.
- Take treponemal and quantitative non-treponemal tests and lesion PCR where available before treatment.
- Document previous syphilis results and treatment, symptoms, neurological or sensory features, pregnancy and timing of possible acquisition.
Key medicines
Benzathine benzylpenicillin for early syphilisGive 2.4 million units intramuscularly once, usually divided between two gluteal sites according to product and local administration protocol.
Benzathine benzylpenicillin for late latent syphilisGive 2.4 million units intramuscularly once weekly for three doses for late latent or unknown-duration infection.