Treatment of Early Latent Syphilis (Acquired Within 2 Years) in Non-Pregnant Patients
Early latent syphilis — defined as syphilis acquired within the past 2 years in the absence of active clinical signs — requires careful staging before treatment. This protocol applies to non-pregnant adults confirmed or staged as early latent.
Clinical Scenario
The latent stage is classified as early when acquisition occurred within 2 years, and late thereafter. For patients without a confirmed history of prior treatment, staging as early or late is required, as it directly determines which treatment regimen is appropriate.
Treatment Approach
The primary intervention involves injectable penicillin-based therapy. Alternative antibiotic regimens exist for patients in whom penicillin is not appropriate. The complete regimen — including specific agents, routes, and duration — is available in the full protocol.
Treatment Goals & Follow-Up
A four-fold decrease in the RPR titre is expected following treatment. Serological follow-up is recommended at 3, 6, and 12 months, continuing until the RPR is negative or the titre is serofast.
References
The latent stage is defined as early within 2 years, and late thereafter (ending with the development of tertiary disease).
For those without a confirmed history of treatment, syphilis should be staged as early (within 2 years of acquisition) or late (more than 2 years since acquisition) in order to determine the recommended penicillin regimen.
It may take a number of months for the non-treponemal titres to drop 4-fold following treatment, particularly following treatment of re-infection.
Clinical and serological (RPR tests) follow-up is recommended at 3, 6 and 12 months then, if indicated, six monthly until RPR negative or serofast.
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