AEDV Expert Consensus for the Management of Syphilis

Area of Science:

• Infectious Diseases
• Public Health
• Epidemiology

Background:

• Syphilis is experiencing a resurgence in Western nations, characterized by increasing incidence rates, particularly among men, as evidenced by Spain's 2021 data.
• The disease presents a wide spectrum of clinical manifestations, ranging from typical lesions to atypical presentations like Follmann balanitis and oral lesions, complicating diagnosis.
• Changes in sexual behavior contribute to the re-emergence, necessitating updated public health strategies.

Framework:

• Modern syphilis diagnostics integrate molecular assays like PCR for ulcerative lesions and automated treponemal tests (EIA, CLIA) for serology.
• Classical tests such as RPR and HAART remain vital for confirmation and monitoring treatment response.
• Interpretation of diagnostic tests requires careful consideration of the patient's clinical and epidemiological context.

Implementation:

• Co-screening for HIV and other sexually transmitted infections (STIs) is recommended for all syphilis patients.
• Regular follow-up, including serological testing at 3, 6, 12, and 24 months, is essential for monitoring treatment efficacy and detecting reinfection, especially in people living with HIV (PLHIV).
• Management includes partner notification and treatment, alongside universal screening for pregnant women, particularly those with a history of abortion after 20 weeks gestation.

Implications:

• Penicillin remains the primary treatment for all syphilis stages and populations, including pregnant women and PLHIV.
• The emergence of macrolide resistance underscores the importance of adhering to recommended treatment protocols.
• Effective syphilis control requires a multi-faceted approach encompassing diagnostics, treatment, follow-up, and public health surveillance.