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Penicillin Allergy Delabelling Syphilis — SCE Infectious Diseases MCQ

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HardAntimicrobial StewardshipPenicillin Allergy Delabelling SyphilisSCE Infectious Diseases

A patient labelled penicillin-allergic after a non-immediate maculopapular rash during adolescent pharyngitis now needs preferred treatment for syphilis. What is the best next step?

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Correct answer: A — Use structured history and risk-stratified testing to assess penicillin tolerance

The best answer is “Use structured history and risk-stratified testing to assess penicillin tolerance”. Many penicillin labels are incorrect, including rashes during viral illness; formal assessment can restore safe first-line treatment while genuine severe delayed reactions remain contraindications. A structured history and risk-stratified testing can remove incorrect penicillin-allergy labels and preserve first-line treatment for infections such as syphilis. A sustained fourfold rise in non-treponemal titre after prior treatment supports reinfection or treatment failure and requires clinical reassessment and retreatment.

Reference: BSACI guideline collection for drug allergy: https://www.bsaci.org/guidelines/ BASHH syphilis guideline: https://www.bashh.org/resources/25/syphilis_2024/