Syphilis Prevention

Avoidance of sexual contact is the only completely reliable method of prophylaxis but is an impractical public health measure for obvious reasons. Annual screening for syphilis among men who have sex with men has been recommended based on preliminary data suggesting that this may decrease the rate of transmission. High-risk individuals (those who have multiple encounters with anonymous partners or who have sex in conjunction with the use of drugs) should be screened every 3-6 months.

A. Mechanical

The standard latex condom is effective but protects covered parts only. The exposed parts should be washed with soap and water as soon after contact as possible. This applies to both sexes.

B. Antibiotic

If there is known exposure to infectious syphilis, abortive penicillin therapy may be used. Give 2.4 million units of procaine penicillin G intramuscularly. Azithromycin administered as a single 1 g dose is also effective as preventive therapy in individuals exposed to infected partners, and in some areas Public Health Departments are giving syphilis patients azithromycin packets to give to sexual contacts whom they meet in high-risk venues. Treatment of gonococcal (and chlamydial) infection with tetracyclines and ceftriaxone is probably effective against incubating syphilis in most cases. However, other antimicrobial agents (eg, spectinomycin, quinolones) may be ineffective in aborting preclinical syphilis. Because of concerns about treating incubating syphilis with nonpenicillin regimens, patients treated for gonorrhea should have a serologic test for syphilis 3-6 months after treatment.

Course & Prognosis

The lesions associated with primary and secondary syphilis are self-limiting and resolve with few or no residua. Late syphilis may be highly destructive and permanently disabling and may lead to death. In broad terms, if no treatment is given, about one-third of people infected with syphilis will undergo spontaneous cure, about one-third will remain in the latent phase throughout life, and about one-third will develop serious late lesions.