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Syphilis — SCE Infectious Diseases MCQ

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ModerateSTIsSyphilisSCE Infectious Diseases

A 40-year-old man with HIV (CD4 350, VL <50 on DTG/TAF/FTC) presents with a new diagnosis of latent syphilis of unknown duration. RPR is 1:64. He has no neurological symptoms. What is the appropriate treatment?

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Correct answer: B — Benzathine Penicillin G 2.4 MU IM weekly for 3 consecutive weeks

Late latent syphilis (>2 years duration or unknown duration) is treated with Benzathine Penicillin G 2.4 MU IM weekly for 3 doses (weeks 0, 1, and 2). This applies equally to HIV-positive patients without neurological involvement. A single dose would only be appropriate for early syphilis (<2 years). Neurosyphilis is excluded clinically but lumbar puncture should be considered if any neurological/ophthalmic/otic symptoms develop. RPR should be monitored at 3, 6, 12, and 24 months for a fourfold decline.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/infections