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   A 30-year-old ba...

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Year : 2000  |  Volume : 66  |  Issue : 2  |  Page : 87

How I manage

Correspondence Address:
K Pavithran

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Source of Support: None, Conflict of Interest: None

PMID: 20877035

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How to cite this article:
Pavithran K. How I manage. Indian J Dermatol Venereol Leprol 2000;66:87

How to cite this URL:
Pavithran K. How I manage. Indian J Dermatol Venereol Leprol [serial online] 2000 [cited 2020 Jun 4];66:87. Available from: http://www.ijdvl.com/text.asp?2000/66/2/87/4877

  A 30-year-old bachelor's blood VDRL was reported as reactive 1:8 on two occasions. Twelve years back he had sexual intercourse with a commercial sex worker. He doesn't remember having any genital sore in the past. How will you manage this patient. Top

The patient has a low VDRL titre on testing the blood. First of all a specific test such as TPHA test should be done to confirm that bood VDRL positivity is truely syphilitic origin. In case no genital or skin lesions are associated and if there are no clinical evidences of cardiovascular or neurosyphilis, the possibility of 'latent syphilis' is to be considered. Before labelling as 'latent syphilitic, a CSF study including cell count and CSF VDRL to exclude neurosyphilis, and screening of aorta to exclude aneurism should be performed.

'Latent syphilis' of less than 2 years dura­tion of infection should be treated as for early syphilis ie. inj. benzathine penicillin 2.4 mega units deep IM as single dose. If patient is allergic to penicillin he can be given oral doxycycline 100mg bid X 15 days.

If patient denies consent for lumbar puncture and CSF study or if latent syphilis is of more than 2 years duration or if patient has syphilis of unknown duration (SUD), or if patient has associated HIV infection he should be given treatment as for neurosyphilis which consists inj.benzyl penicillin 2-4 million units, every 4 hours, intravenously for 10-14 days followed by inj benzathine penicillin 2.4 mega units deep IM.

If the patient is allergic to penicillin, treat­ment consists oral doxycyclin,100 mg bid for 30 days.

After treatment a rapid fall in VDRL titre may occur if latent syphilis is early. In case of late latent syphilis the titre may not fall at all. Further treatment is not indicated in such cases unless there is a persistent 4-fold rise in VDRL titre (eg 1:8 becomes 1:32) on follow up.


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