Therapy of syphilis
The antibiotic penicillin is still the method of choice for therapy of the syphilis. The administration, dosage and duration of therapy depend on the disease stage and the clinical Symptoms of Syphilis from. The duration of therapy must be at least 2 weeks, or 3 weeks if infections are suspected to be in the past. Sex partners who have been exposed to an infection in the last 3 months should receive additional therapy regardless of the serological result. In the pregnancy is Penicillin G the means of choice. Patients who are allergic to penicillin should be desensitized and then treated.
The Jarisch-Herxheimer reaction occurs as a rare complication of syphilis therapy with penicillin G. The rapid, massive disintegration of the pathogen under the action of penicillin releases large amounts of toxic bacterial components. This leads to fever of up to 40 ° C, headache, muscle pain (Myalgia), Palpitations (Tachycardia) and decreased blood pressure (Hypotension). The Jarisch-Herxheimer reaction subsides after 1-2 days and occurs in around 40-50% of the pregnant women treated.
After the treatment of syphilis im Stage I or II controls are carried out 3, 6 and 12 months after the end of therapy using the VDLR- and TPHA- Tests in connection with the detection of newly formed antibodies (IgM ab). This is followed by annual controls over a number of years. A quarterly check-up is advisable for patients who belong to a risk group for sexually transmitted diseases.
In stage III and IV syphilis, serum and liquor must be checked every six months for 3 years.
For a successful treatment of syphilis, the non-specific antibodies against cardiolipin must drop to 0 within 6-12 months. The specific ones remain lifelong in the sense of the serological scar.
Offer as an exposure prophylaxis Condoms Protection from transmission. Symptomatic patients should not have sexual intercourse. Since the pathogen can easily be infected by smear infections of lesions of the Stage I. and II (see also: Symptoms of syphilis), gloves must be worn during the examination by doctors. A Vaccination against T. pallidum there is not any.
All Pregnant women and all blood donors are screened for antibodies to T. pallidum. For prophylaxis of Syphilis connata Careful prenatal care, which includes testing for antigen-antibody reactions, is used.
The syphilis or the direct or indirect proof of Treponema pallidum is not notifiable by name in Germany (§ 7 IfSG).