Patient Counseling and Education
Patient counseling and education should cover the nature of the disease, transmission, treatment and follow-up, and risk reduction.
Nature of the Disease
- Syphilis may be symptomatic or asymptomatic.
- Because syphilis is a systemic infection, extra-genital symptoms (such as rashes and alopecia) may occur.
- Untreated syphilis in pregnancy can lead to death or severe disability in the fetus.
- Sequelae of untreated syphilis include neurologic and cardiovascular disorders.
- Syphilis is transmitted sexually or vertically (from pregnant mother to fetus).
- Syphilis is most infectious during the primary and secondary stages (when lesions or rashes are present). However, lesions may be inapparent. All at-risk sex partners need to be evaluated and possibly treated.
- Syphilis is associated with increased susceptibility to HIV acquisition.
Treatment and Follow Up
- If treated with penicillin, the Jarisch-Herxheimer reaction may occur.
- Return for follow-up serology at 6 and 12 months (every
3 months if HIV-positive).
- The patient may be “serofast” or have positive treponemal
and nontreponemal serologic tests for life.
The clinician should:
- Assess the patient’s potential for behavior change.
- Discuss prevention strategies such as abstinence,
mutual monogamy with an uninfected partner, use of condoms, and limiting the number of sex partners.
- Discuss latex condoms, which when used consistently and correctly, can reduce the risk of syphilis transmission only when the infected area or site of potential exposure is protected. Genital ulcer diseases including syphilis can occur in male or female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered.
- Discuss individualized risk-reduction plans.