[Question #5501] Syphilis presumptive therapy?
73 months ago
|
Dear Doctors,
I’m a 72
y.o. MD ( Internal Medicine ) from Italy. On the 20th of May ( 19
days ago ) I had an encounter with a 45 y.o.
Italian CSW . We performed a
brief condom protected fellatio and subsequently engaged in protected insertive vaginal sex . At the beginning the
condom slipped off to the floor. I’ m not sure if there was a real penetration
, is possible that a brief contact ( 10-30
sec.s ) between external genitals occurred. Wearing another condom we ended up
with a vaginal intercourse . Due to the
1st condom problem I asked her to check for HIV and syphilis. The
HIV1-2 test ( fourth generation Ag p24
Ab ) turned out to be negative , VDRL qualitative positive, TPHA quantitative
positive ( 1:180 ) .The laboratory states : negative < 1:80 , positive >
1:80 .
The lady
denies previous STD including syphilis , she assures engages only in protected
( male condom ) sex.
Now
questions.
As far as
HIV risk I’m fairly positive ( low risk activity , negativity
of the her test also considering the window period ) . I’ ll perform the duo
test at 4 weeks .
Syphilis.
I don’t
have any sign of changes whatsoever in the penis, scrotum and pubic area . No
general symptoms at all besides anxiety. I had just one vaginal intercourse with my
wife on the 3rd of June, 9
days after the case ( at that time I had
only the report of HIV test ) .
Should I wait
to six weeks and perform VDRL and TPHA or , as I read on CDC 2015 guidelines “ Persons
who have had sexual contact with a person who receives a diagnosis of primary,
secondary, or early latent syphilis within 90 days preceding the diagnosis
should be treated presumptively for early syphilis, even if serologic test
results are negative.”
Should I initiate therapy with
benzatin penicillin 2.4 million once ( I’ m not allergic to penicillin ) and in
that case this “ presumtive therapy “ could invalidate subsequent serological
tests ? Most of all I want to spare my wife any risk and possibly any need of
testing or therapy and solve the case ASAP with a shot of penicillin if
necessesary.
Thank you
for yor help and congratulations for your outstanding service.
Elias
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Edward W. Hook M.D.
73 months ago
|
73 months ago
|
73 months ago
|
73 months ago
|
![]() |
Edward W. Hook M.D.
73 months ago
|
73 months ago
|
![]() |
Edward W. Hook M.D.
73 months ago
|