Treatment of Tertiary Syphilis with Cardiovascular Aortitis (Ascending Aorta)
Cardiovascular involvement is a recognised presentation of tertiary syphilis. This protocol addresses syphilitic aortitis — typically of the ascending aorta — with aortic regurgitation, diagnosed on the basis of typical clinical features and positive syphilis serology after other causes have been excluded.
Clinical Scenario
Cardiovascular tertiary syphilis: aortitis of the ascending aorta presenting with aortic regurgitation. Diagnosis is established by typical clinical features combined with positive syphilis serology after exclusion of other causes. Cardiovascular syphilis typically manifests 15–30 years after the initial infection.
Treatment Approach
Management centres on antibiotic therapy combined with a short course of corticosteroid cover, with steroids commenced before antibiotics are started. The full protocol specifies multiple antibiotic options alongside the steroid regimen.
Complete regimen details — antibiotic options, durations, and steroid dosing — are available in the full structured protocol.
References
- The diagnosis of cardiovascular syphilis is made by the presence of the typical clinical features combined with positive syphilis serology after exclusion of other causes.
- Cardiovascular syphilis typically occurs 15–30 years after infection.
- Benzathine penicillin 2.4 MU IM weekly for 3 weeks (three doses): 1C.
- Doxycycline 100 mg PO BD for 28 days: 2D.
- Amoxycillin 2 g PO three times daily (TDS) PLUS probenecid 500 mg QDS for 28 days: 2C.
- Ceftriaxone 2 g IM or IV for 10–14 days: 2D.
- Steroids should be given with all anti-treponemal antibiotics for cardiovascular syphilis; 40–60 mg prednisolone OD for 3 days starting 24 h before the antibiotics.
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