Patients being treated for primary and secondary syphilis should have RPR serology repeated on the day treatment is commenced to provide an accurate baseline for monitoring treatment response.

• 🍒What additional blood test should be performed in primary and secondary syphilis for monitoring treatment response
• 🍒How does the rash in secondary syphilis appear

Jarisch-Herxheimer reaction is a common reaction to treatment in patients with primary and secondary syphilis. It occurs 6-12 hours after commencing treatment, and is an unpleasant reaction of varying severity with fever, headache, malaise, rigors and joint pains, and lasts for several hours. Symptoms are controlled with analgesics and rest.

• 🍒A patient develops fever, headache, malaise, rigors and joint pain 6-12 hours after receiving benzathine benzylpenicillin for syphilis. What is the diagnosis
• Advise no sexual contact for 7 days after treatment is commenced, or until the course is completed and symptoms resolved, whichever is later.
• Advise no sex with partners from the last 3 months (primary syphilis), 6 months (secondary syphilis) or 12 months (early latent) until the partners have been tested and treated if necessary.

Review all patients clinically and with repeat RPR testing at 3 months, then at 6 months and (if necessary) at 12 months after completing treatment. A 4-fold drop (e.g. 1:8 to 1:2) indicates adequate response to treatment.