Today we continue the STI saga with the story of syphylis, caused by the spirochete Treponema pallidum.
The CDC Pocket Guide to Syphilis contains absolutely essential information for providers regarding screening and treatment of this STI in a colorful and easy-to-read format. ACOG supports the CDC and USPSTF guidelines regarding syphilis treatment and screening.
For screening: all pregnant women should be screened at a new OB visit, and reconsideration for screening should be given in the third trimester. For women more generally, screening should be offered annually if the patient is HIV-positive and sexually active or if engaged in high-risk behaviors such as exchanging sex for money. A positive screening test should always be followed with a diagnostic test. Reverse-screening is also now used in some institutions (confirmatory/diagnostic followed by screening, as the screening test is used to follow treatment response).
We review treatment fairly extensively in the podcast, with the bottom line being benzathine penicillin is generally the drug of choice. Below we share some tables from a nice review on syphilis, published in the Columbia Medical Review. Happy studying!