Update on the diagnosis and treatment of syphilis.

Please cite this article as: Morales-Múnera C, FuentesFinkelstein P, Vall Mayans M. RR -Sífilis: actualización en el manejo diagnóstico y terapéutico. Actas Dermosifiliogr. 2015;106:68--69. ∗ Corresponding author. E-mail addresses: [email protected], [email protected] (C.E. Morales-Múnera). Both serology tests should be performed together; when performed separately, they lose their diagnostic value because of the increase in false positives. Follow-up is with nontreponemal tests, since fluctuations in the results mirror disease activity, and should always be with the same nontreponemal test used in the initial diagnosis, preferably from the same manufacturer. It is important to remember that, just as treponemal tests tend to remain positive and fluctuations in the results are not indicative of disease activity, nontreponemal do not yield negative results in tests in a high percentage of appropriately treated patients. Treatment is still based on intramuscular penicillin G benzathine administered in a single dose of 2 400 000 U for primary syphilis, secondary syphilis, and early latent syphilis and intramuscular penicillin G benzathine administered at 2 400 000 U weekly for 3 weeks in the case of late latent or indeterminate syphilis and tertiary syphilis. Patients who are allergic to penicillin can receive oral doxycycline at 100 mg twice daily for 14-28 days depending on the stage of the disease; in the case of penicillin-allergic pregnant women, the recommendation continues to be desensitization followed by penicillin G benzathine. Patients should undergo clinical and laboratory followup every 3-6 months for 1 year. Decreased values in the nontreponemal test are considered a good response to treatment. Patients whose values do not decrease by at least 2 dilutions should be evaluated bearing in mind the possibility of neurosyphilis, and patients whose values increase by at least 2 dilutions in the nontreponemal tests should be re-treated, since they may be experiencing reinfection.