Syphilis management for tertiary stage: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Syphilis}} | {{Syphilis}} | ||
{{CMG}}; {{AOEIC}} {{LG}} | {{CMG}}; {{AOEIC}} {{LG}}{{AA}}; {{NRM}} | ||
==Overview== | ==Overview== | ||
[[Syphilis pathophysiology#Tertiary syphilis|Tertiary syphilis]] refers to [[Syphilis physical examination#Tertiary syphilis: Gumma|gumma and cardiovascular syphilis]] but not to all [[Neurosyphilis#Clinical presentation: Four clinical types|neurosyphilis]]. Patients who are not [[Syphilis medical therapy#Pencillin allergy|allergic to penicillin]] and have no evidence of [[neurosyphilis]] should be treated with | [[Syphilis pathophysiology#Tertiary syphilis|Tertiary syphilis]] refers to [[Syphilis physical examination#Tertiary syphilis: Gumma|gumma and cardiovascular syphilis]] but not to all [[Neurosyphilis#Clinical presentation: Four clinical types|neurosyphilis]]. Patients who are not [[Syphilis medical therapy#Pencillin allergy|allergic to penicillin]] and have no evidence of [[neurosyphilis]] should be treated with [[Penicillin#Benzylpenicillin (penicillin G)|Benzathine penicillin G]] 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervals. | ||
==Management for Tertiary Stage Syphilis== | ==Management for Tertiary Stage Syphilis== | ||
===CDC Recommendations: Pharmacotherapy | ===CDC Recommendations: Pharmacotherapy=== | ||
====Recommended Regimen==== | ====Recommended Regimen==== | ||
*[[Penicillin#Benzylpenicillin (penicillin G)|Benzathine penicillin G]] 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervals.<ref name="urlSexually Transmitted Diseases Treatment Guidelines, 2010">{{cite web |url=http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5912a1.htm |title=Sexually Transmitted Diseases Treatment Guidelines, 2010 |format= |work= |accessdate=2012-12-19}}</ref><ref name=cdc2015>http://www.cdc.gov/std/tg2015/syphilis.htm#Neurosyphilis Accessed on September 27, 2016</ref> | |||
===Other Management Considerations=== | ===Other Management Considerations=== | ||
Patients who have [[Syphilis history and symptoms#Tertiary syphilis|symptomatic late syphilis]] should be given a [[Syphilis laboratory findings#CSF analysis|CSF examination]] before therapy is initiated. | Patients who have [[Syphilis history and symptoms#Tertiary syphilis|symptomatic late syphilis]] should be given a [[Syphilis laboratory findings#CSF analysis|CSF examination]] before therapy is initiated. Patients with cardiovascular syphilis may be treated with the same regimen as neurosyphilis but there is limited data available to support this.<ref name="pmid17469346">{{cite journal| author=Carrada-Bravo T| title=[Cardiovascular syphilis: diagnosis, treatment]. | journal=Arch Cardiol Mex | year= 2006 | volume= 76 Suppl 4 | issue= | pages= S189-96 | pmid=17469346 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17469346 }} </ref> | ||
===Special Considerations=== | ===Special Considerations=== | ||
====Penicillin Allergy: Alternative Regimen==== | ====Penicillin Allergy: Alternative Regimen==== | ||
Patients [[Syphilis medical therapy#Pencillin allergy|allergic to penicillin]] should | * Patients [[Syphilis medical therapy#Pencillin allergy|allergic to penicillin]] should consult with an infectious disease specialist to determine an effective regimen. | ||
====Pregnancy==== | ====Pregnancy==== | ||
Pregnant patients who are allergic to penicillin should be [[desensitize]]d and treated with [[penicillin]]. | * Pregnant patients who are allergic to penicillin should be [[desensitize]]d and treated with [[penicillin]]. | ||
===Follow-Up=== | ===Follow-Up=== | ||
Limited information is available concerning clinical response and follow-up of patients who have [[Syphilis pathophysiology#Tertiary syphilis|tertiary syphilis]]. | * Limited information is available concerning clinical response and follow-up of patients who have [[Syphilis pathophysiology#Tertiary syphilis|tertiary syphilis]]. | ||
==References== | ==References== | ||
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[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Gynecology]] | [[Category:Gynecology]] | ||
[[Category:Bacterial diseases]] | [[Category:Bacterial diseases]] | ||
[[Category:Sexually transmitted diseases]] | [[Category:Sexually transmitted diseases]] | ||
[[Category:Emergency mdicine]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | |||
[[Category:Urology]] | |||
[[Category:Neurology]] |
Latest revision as of 00:23, 30 July 2020
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Syphilis management for tertiary stage On the Web | |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]Aysha Anwar, M.B.B.S[3]; Nate Michalak, B.A.
Overview
Tertiary syphilis refers to gumma and cardiovascular syphilis but not to all neurosyphilis. Patients who are not allergic to penicillin and have no evidence of neurosyphilis should be treated with Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervals.
Management for Tertiary Stage Syphilis
CDC Recommendations: Pharmacotherapy
Recommended Regimen
- Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervals.[1][2]
Other Management Considerations
Patients who have symptomatic late syphilis should be given a CSF examination before therapy is initiated. Patients with cardiovascular syphilis may be treated with the same regimen as neurosyphilis but there is limited data available to support this.[3]
Special Considerations
Penicillin Allergy: Alternative Regimen
- Patients allergic to penicillin should consult with an infectious disease specialist to determine an effective regimen.
Pregnancy
- Pregnant patients who are allergic to penicillin should be desensitized and treated with penicillin.
Follow-Up
- Limited information is available concerning clinical response and follow-up of patients who have tertiary syphilis.
References
- ↑ "Sexually Transmitted Diseases Treatment Guidelines, 2010". Retrieved 2012-12-19.
- ↑ http://www.cdc.gov/std/tg2015/syphilis.htm#Neurosyphilis Accessed on September 27, 2016
- ↑ Carrada-Bravo T (2006). "[Cardiovascular syphilis: diagnosis, treatment]". Arch Cardiol Mex. 76 Suppl 4: S189–96. PMID 17469346.