Syphilis is a systemic disease caused by Treponema pallidum. Syphilis is characterized by episodes of active disease (primary, secondary, tertiary stages) interrupted by periods of latency. The diagnosis of syphilis may involve dark?field microscopy of skin lesions but most often requires screening with a nontreponemal test and confirmation with a treponemal?specific test. Parenterally administered penicillin G is considered first?line therapy for all stages of syphilis.
Alternative regimens for nonpregnant patients with no evidence of central nervous system involvement include doxycycline, tetracycline, ceftriaxone, and azithromycin. In pregnant women and congenital syphilis, penicillin remains the only effective treatment option; if these patients are allergic to penicillin, desensitization is required before treatment is initiated.. Once the diagnosis of syphilis is confirmed, quantitative nontreponemal test titers should be obtained. These titers should decline fourfold within six months after treatment of primary or secondary syphilis and within 12 to 24 months after treatment of latent or late syphilis.
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