Sexually transmitted disease

4 types

Primary syphilis

Firm  and painless chancre/lesion on the penis

Inguinal lymphadenopathy- Non-suppurating generally

Usually resolves in 4 weeks even if untreated

This may progress to latent syphilis

Secondary syphilis



Aches and pain

Eczema looking rash or coppery rash maculopapular eruption on face, trunk, palm and soles. The rash is general, not itchy or painful

Patchy alopecia- scalp and outer 3rd of eyebrow

Condylomata lata- warty growth in skinfolds

Painless lymphadenopathy (Preauricular, Occipital, posterior cervical, axillary, inguinal)

Oral/ pharyngeal and genital ulcers

Snail track ulcer

Latent syphilis


Commonest presentation in Australia

Late syphilis

Granulomatous lesion- Gummas in any organ mainly cardiovascular and CNS




Neurosyphilis (Cranial nerve palsy, tabes dorsalis, Dementia)

Aortic aneurysm

Increased risk of HIV infection



Nontreponemal (or nonspecific) serological tests for syphilis

Rapid plasma reagin (RPR) test

Venereal disease research laboratory (VDRL) test

This test is non-specific and could be falsely positive in conditions such as pregnancy and autoimmune diseases

The titre of a nontreponemal test provides an index of the activity of syphilis infection and is used to monitor response to treatment. The RPR titre should be repeated at 3, 6, and 12 months after treatment. A fourfold drop in titre 6 months following treatment is indicative of an adequate response to treatment.

Treponemal (or specific) serological tests for syphilis include:

  1. pallidum particle agglutination (TPPA)
  2. pallidum haemagglutination (TPHA)

Fluorescent treponemal antibody absorbed (FTA-ABS) test, and • enzyme immunoassay (EIA

The above test confirms the diagnosis.

Note: Syphilis serology be done as part of the routine STI screening in MSM (Men having sex with Man) and also needs to be considered in the Aboriginal community


Primary, secondary or early latent syphilis

Benzathine penicillin 1.8 g (2.4 mU) IM as a single dose


Procaine penicillin 1.0 g IM daily for 10 days

If penicillin allergic and not pregnant then,

Doxycycline 100 mg orally twice daily for 14 days†

Late latent or syphilis of unknown duration

Benzathine penicillin 1.8 g (2.4 mU) IM once weekly for three doses


Procaine penicillin 1.0 g IM daily for 15 days

If penicillin allergic then

Doxycycline 100 mg orally twice daily for  28 days


Immediate treatment should be offered for sexual contacts of syphilis without waiting for the results of serology if sexual contact with a person with infectious syphilis occurred less than 90 days ago, as syphilis serology may still be negative. Contacts should be offered a single dose of intramuscular benzathine penicillin,

Contact tracing

Disease notification





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