At-risk sex partners are determined based on the
patient's diagnosed stage of disease. Partners exposed during the following time periods before
the patient recieves treatment should be considered at-risk:
Primary: 3 months plus duration of symptoms
Secondary: 6 months plus duration of symptoms
Early latent: 1 year
Presumptive treatment should be given to those persons who were exposed within the 90 days preceding a sex partner's diagnosis of primary, secondary, or early latent syphilis, because they might be infected, even if seronegative.
Persons who were exposed >90 days before a sex partner's diagnosis of primary, secondary, or early latent syphilis should also 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., >1:32) may be considered as having early syphilis. However, serologic titers should not be used to differentiate early from late latent syphilis for the purpose of determining treatment.
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 findings of the evaluation.
Reporting and Public Health Follow Up
Patients with primary, secondary or early latent
syphilis, or syphilis of unknown duration with a high
nontreponemal serologic test titer (i.e., >1:32), should be
referred to the local health department STD program for
interview, partner elicitation, and partner follow up.
The follow up of patients with early syphilis is a public
health priority. Laws and regulations in all states
require that persons diagnosed with syphilis be reported to
public health authorities. Reporting can be provider or
laboratory based. Providers unsure of reporting requirements
should seek advice from state or local health departments or
STD Programs. Click here for links to state and local public health departments.
- Pregnant women should be screened and counseled at least at the first prenatal visit.
- For communities and populations in which the prevalence of syphilis is high, or for patients at risk, serologic testing should be performed twice during the third trimester, at 28 weeks, and at delivery, in addition to routine early screening.
- Any woman who gives birth to a stillborn infant after 20 weeks gestation should be tested for syphilis.
- No infant should leave the hospital without the maternal serologic status having been determined at least once during pregnancy and preferably again at delivery.
- Other populations should be selected for screening based on local prevalence of syphilis and the patient’s risk behaviors. Contact your state/local health department for populations at risk and for screening recommendations in your area.