Syphilis Serology

Overview

Syphilis screening is recommended for all adult refugees. The interpretation of syphilis serology can be complex and depends on the patient's history.

Interpretation

Positive Screening Test

If the initial screening test (usually RPR or VDRL) is positive:

1. Confirm with treponemal test (TP-PA, FTA-ABS)
2. Determine stage of infection
3. Check for neurosyphilis if indicated

Treatment

Treatment depends on the stage:

• Primary, secondary, early latent: Benzathine penicillin G 2.4 million units IM once
• Late latent or unknown duration: Benzathine penicillin G 2.4 million units IM weekly x 3
• Neurosyphilis: IV penicillin G - refer to specialist

Follow-up

Monitor RPR titers at 6 and 12 months (and 24 months for late latent). A 4-fold decline indicates adequate treatment response.