Health Advisory
SYPHILIS DIAGNOSIS AND TREATMENT REMINDER

The Delaware Division of Public Health wishes to alert the Delaware medical community about an increase in syphilis cases among men who have sex with men (MSM).

Delaware has also seen an increase in primary and secondary syphilis cases. The 20 reported cases for 2006 represents a twofold increase compared to 2005 (11). Fifteen of the cases diagnosed in 2006 are male cases and 11 of those are MSM.

These facts serve as a reminder that the following information from the 2006 STD Treatment Guidelines should be considered when diagnosing and managing all cases of syphilis and their contacts.

Patients who are infected with syphilis may seek treatment for the signs or symptoms of primary infection such as an ulcer or chancre at the infection site, or secondary infection manifestations that include, but are not limited to, unexplained skin rash, mucocutaneous lesions (including but are not limited to, genital, anogenital, or oral lesions) and lymphadenopathy.

Persons exposed sexually to a patient who has syphilis in any stage should be evaluated clinically and serologically and treated with a recommended regimen, according to the following recommendations:

• Persons who were exposed within the 90 days preceding the diagnosis of primary, secondary, or early latent syphilis in a sex partner might be infected even if seronegative; therefore, such persons should be treated presumptively.
• Persons who were exposed >90 days before the diagnosis of primary, secondary, or early latent syphilis in a sex partner should be treated presumptively if serologic test results are not available immediately and the opportunity for follow-up is uncertain.

Syphilis Treatment:

This information is extracted from the 2006 CDC STD Treatment Guidelines

STAGE OF DISEASE	RECOMMENDED TREATMENT	ALTERNATIVES
PRIMARY, SECONDARY OR EARLY LATENT (< 1 YEAR)	Adults: Benzathine penicillin G 2.4 million units IM in a single dose Children: Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of 2.4 million units in a single dose	See CDC Treatment Guidelines
LATE LATENT (> 1 YEAR) OR LATENT OF UNKNOWN DURATION	Adults: Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1 week intervals Children: Benzathine penicillin G 50,000 units/kg IM up to the adult dose of 2.4 million units, administered as 3 doses at 1 week intervals (total 150,000 units/kg up to the adult total dose of 7.2 million )	See CDC Treatment Guidelines
PREGNANCY	Penicillin is the only recommended treatment for syphilis during pregnancy. Women who are allergic should be desensitized and then treated with penicillin. Dosages are the same as in non-pregnant patients for each stage of syphilis. Erythromycin has an unacceptable failure rate to cure the infected fetus and is therefore not recommended.	See CDC Treatment Guidelines

For additional information, you may contact the Division of Public Health Sexually Transmitted Disease Program office at (302) 741-2920.