Follow-up investigations for syphilis

Check response to syphilis treatment at 3, 6 and 12 months with a rapid plasma reagin [RPR] test. Syphilis is considered cured if the RPR titre falls by at least 4-fold (2 dilutions). A 4-fold decrease in the RPR titre occurs in about two-thirds of treated syphilis cases by 12 months.

Document curative treatment in the patient’s medical history.

Consider treatment failure (particularly in patients treated with a nonpenicillin regimen) or reinfection ifTong, 2013:

• a 4-fold decrease in the RPR titre does not occur within 12 months
• RPR titre increases
• symptoms persist or reoccur.

Advise patients that despite curative treatment, their treponemal test (eg treponemal enzyme immunoassay [EIA], T. pallidum particle agglutination test [TPPA], chemiluminescent microparticle immunoassays [CMIAs], T. pallidum haemagglutination assay [TPHA]) will probably remain reactive for life.

For patients who had an initial cerebrospinal fluid (CSF) examination, a repeat CSF examination is not required unless there is clinical or serological treatment failure.