Prognosis

Natural course of infection

Treatment is curative once antibiotic treatment is completed. However, re-infection may occur if there is further exposure to syphilis.

The natural course of organ-specific involvement is determined by the stage of syphilis at diagnosis and whether appropriate treatment has been administered. Follow-up of organ-specific complications requires specialist opinion (e.g., cardiology assessment of aortic regurgitation; neurology assessment of tabes dorsalis).

Serology test results

Treponemal-specific tests remain reactive lifelong; therefore, they are unable to differentiate between current (active) and past infections. Nor can they be used to monitor response to treatment.

Patients should be informed that future treponemal-specific testing will reveal previously treated syphilis infection.

Non-treponemal tests show a decline in titres or become non-reactive (negative) with effective treatment and are, therefore, used as a quantitative marker of treatment response. Titres should decline fourfold within 6 months after treatment of primary or secondary syphilis, and within 12-24 months after treatment of latent or late syphilis.[108]

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