Syphilis: Essential Questions for Your Doctor and Testing Guide

Syphilis is a sexually transmitted infection caused by Treponema pallidum. It progresses through stages and is curable with penicillin. Open communication with your provider ensures accurate diagnosis and treatment.

Key Questions to Ask Your Doctor

1. Testing: "Which tests are you ordering? (RPR/VDRL + treponemal confirmatory). What do reactive/non-reactive results mean at each stage?"
2. Staging: "Based on my history and exam, what stage do you suspect? (Primary, secondary, latent, tertiary)."
3. Treatment: "What is the recommended regimen? (Penicillin G benzathine – dose/duration by stage). What if I'm penicillin-allergic?"
4. Follow-up: "What is the follow-up schedule for serologic monitoring? (RPR titers at 6, 12, 24 months)."
5. Partner notification: "How should I notify partners? Can the health department assist confidentially?"
6. Congenital risk: "If pregnant, what is the treatment and monitoring plan for me and the baby?"
7. Co-infections: "Should I be tested for HIV, chlamydia, gonorrhea, hepatitis B/C?"
8. Neurosyphilis: "Do I need a lumbar puncture? (Indicated: neurologic/ocular signs, treatment failure, HIV with late latent/high titer)."

Testing Algorithm (CDC)

• Traditional: Screen with nontreponemal (RPR/VDRL) → if reactive, confirm with treponemal (TP-PA, FTA-ABS, EIA/CIA).
• Reverse sequence (common now): Screen with treponemal (EIA/CIA) → if reactive, reflex to nontreponemal (RPR) for titer + second treponemal if discordant.
• Interpretation: Reactive treponemal = past or current infection. RPR titer correlates with disease activity (↓ 4-fold = treatment response).

Treatment (Penicillin Allergy)

• Primary/secondary/early latent: Doxycycline 100 mg BID × 14 days (or tetracycline). Ceftriaxone 1 g IM daily × 10–14 days (alternative).
• Late latent/tertiary: Doxycycline 100 mg BID × 28 days.
• Pregnancy: Penicillin only (desensitize if allergic).
• Neurosyphilis: Aqueous penicillin G 18–24 MU IV daily × 10–14 days (no oral alternative).

Prevention

• Condoms reduce but don't eliminate risk (lesions may be outside covered area).
• Regular screening per risk (MSM, HIV+, pregnancy, multiple partners).
• Expedited partner therapy not recommended for syphilis (requires evaluation).

Early detection and treatment prevent irreversible damage. Don't hesitate to ask questions.