Written by Mira Marchioretto
Spoon Feed
Syphilis is on the rise in certain subgroups. This article provides a well-organized infographic that can be used to summarize treatment and management of patients in all stages of infection.
One infographic to rule them all
The most valuable aspect of the article is a beautifully organized infographic that parses through the nuances of syphilis recognition, management, and care. Below are the top facts presented in this article to consider in day-to-day management of patients.
Syphilis rates are soaring, and in a decade (2011-2020), Canada saw a 385% rise in infections. Females saw a rate increase of 773%, compared to males at 73%, during a 4-year span. Congenital syphilis has also increased over this period. Particular attention should be paid to those patients from lower socioeconomic backgrounds.
There are 4 stages of syphilis, and signs and symptoms as well as time frames from inoculation are well illustrated in the infographic below. A high index of suspicion should be maintained anytime there is concern for sexually transmitted infections (STI), and particular attention should be paid to screen for neurosyphilis, otic, and optic syphilis which can occur at any stage.
Testing algorithms typically start with an enzyme immunoassay (EIA) screen, with rapid plasma reagin (RPR) testing to confirm infection and gauge effectiveness of treatment or reinfection. Depending on symptoms, additional testing may be required, as illustrated in the graphic.
Late latent infections require a longer-term treatment than the standard one-time dose of long-acting benzathine penicillin G.
Infectious disease should be consulted for special populations and complicated presentations as specified in the diagram.
How will this change my practice?
My county of practice (Clark County – includes Las Vegas) ranks number 1 in syphilis rates in the nation. Syphilis is a rising public health crisis everywhere, and physicians need to incorporate the information in this article into their daily practice to recognize and appropriately manage patients presenting with syphilis.
Peer Reviewed by Ketan Patel
Source
Just the facts: diagnosing and managing syphilis in the emergency department. CJEM. 2023 Aug 14. doi: 10.1007/s43678-023-00556-5. Epub ahead of print.
How do you approach STI testing in your Emergency Department? Do you just order Gonorrhea/Chlamydia, or do you perform serum blood testing too?
I usually talk it over with the patient and see what his/her goals are. I explain that concern for one STI raises concern for others. It’s reasonable to send a swab for GC/chlamydia +/- trichomonas and do blood tests for treponemal IgG and RPR, HIV 1-2 Ag/Ab, +/- confirming hepatitis B immunity (Hep B surface antibody). CDC has full STI treatment guidelines and a really great mobile app.