Syphilis management of sexual partners

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]

• Sexual transmission of Treponema pallidum is thought to occur only when mucocutaneous syphilitic lesions are present.

• Although such manifestations are uncommon after the first year of infection, 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:^[1]

• 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 more than 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.

• For purposes of partner notification and presumptive treatment of exposed sex partners, patients with syphilis of unknown duration who have high nontreponemal serologic test titers (i.e., greater than 1:32) can be assumed to have early syphilis. For the purpose of determining a treatment regimen, however, serologic titers should not be used to differentiate early from late latent syphilis.

• Long-term sex partners of patients who have latent syphilis should be evaluated clinically and serologically for syphilis and treated on the basis of the evaluation findings.

• Sexual partners of infected patients should be considered at risk and provided treatment if they have had sexual contact with the patient within:

• 3 months plus the duration of symptoms for patients diagnosed with primary syphilis,
• 6 months plus duration of symptoms for those with secondary syphilis, and
• 1 year for patients with early latent syphilis.^[2]

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