Stages

• Primary – chancre
• Secondary – condylomata latta or rash
• Latent – Early (< 1 yr) vs Late (> 1 yr)
• Tertiary – CNS disease (dementia, tabes dorsalis) aortitis (dissection, aneurysm), Gumma

Workup

• IGg – rapid return, indicates any prior exposure
• RPR – useful for following over time, needs confirmatory treponemal study
• Thorough exam – for any positive result in order to determine stage
• RPR usually not positive yet at chancre stage (dark field for spirochetes?)

Treatment

• PCN G benzathine LA 2.4 million units IM
• Jarisch-Herscheimer very common 24 hrs after injection, lasts ~ 24 hrs
• If late latent needs weekly injections x 3
• If positive test but unable to stage, assume late latent and give the weekly injections
• Any sexual partners in last year should be tested
• Any sexual partners in last 90 days should be treated empirically