7djtK7kw4

POSITIVE SYPHILIS RESULT• First assess and advise the patient with a positive syphilis result and his/her partner/s 23.• Do a RPR/VDRL test in those who are pregnant, sexually assaulted, with a sexually transmitted infection (STI), genital warts, signs of secondary or tertiary syphilis 1 or recently treated for earlysyphilis, as well as those whose partners have an STI or positive RPR result.• If RPR checked before 20 weeks’ gestation, recheck at 34 weeks. Do a rapid VDRL if patient is unbooked in labour or after delivery before discharge.• RPR and VDRL tests reflect disease activity but do not necessarily indicate syphilis infection. They are useful to measure successful response to treatment.• TPHA or FTA tests are specific for syphilis and confirm its diagnosis. They usually remain positive for life.RPR/VDRL positiveNot pregnantIs RPR titre from last 2 years available?PregnantNoDoes patient have a genital ulcer or signs ofsecondary syphilis 1 ?No• Treat for latesyphilis.• Treat partner/s 23.Yes• Treat for earlysyphilis.• Treat partner/s 23.YesNew titre is either:• ≤ 1:8 and unchanged or• at least 4 times lower (eg was 1:32, now 1:8)No• New syphilis infection likely.• Treat for early syphilis.• Treat partner/s 23.Yes• No further treatment needed.• Discharge.• If not already treated, treatpartner/s 23.• Treat for late syphilis• Treat partner/s 23.• If penicillin allergic give erythromycin500mg 6 hourly for 28 days. Once she hasstopped breastfeeding, repeat treatmentwith doxycycline 100mg 12 hourly for 28days 3 .Repeat RPR/VDRL after 3 months.Early syphilis:• Benzathine penicillin 2.4MU IM stat• If penicillin allergic give doxycycline 100mg12 hourly for 14 days.Late syphilis:• Benzathine penicillin 2.4MU IM weekly for 3 weeks• If penicillin allergic and not pregnant give doxycycline100mg 12 hourly for 28 days.Treat the newborn of the RPR positive mother:• Examine the baby.--Well baby: benzathine penicillin 50 000u/kg IMstat.--Signs of congenital syphilis 2 : procaine penicillin50 000u/kg IM daily for 10 days.1The signs of secondary syphilis occur 6–8 weeks after the primary ulcer and include a generalized rash (including palms and soles), flu-like symptoms, flat wart-like genital lesions, mouth ulcers and patchy hair loss. Tertiary syphilis occurs manyyears later and affects skin, bone, heart and nervous system. 2 Signs of congenital syphilis are rash (red/blue spots or bruising especially on soles and palms), jaundice, pallor, distended abdomen due to enlarged liver or spleen, low birthweight,respiratory distress, large, pale placenta, hypoglycaemia. 3 Erythromycin does not reliably cure syphilis in either the mother or the baby.TB HIV CHRONIC RESPIRATORYDISEASECHRONIC DISEASESOF LIFESTYLEMENTAL HEALTH EPILEPSY MUSCULOSKELETALDISORDERS28WOMEN'S HEALTH