Guideline

Southern African HIV Clinicians Society Guideline for the clinical management of syphilis

Remco P.H. Peters, Jeremy S. Nel, Eitzaz Sadiq, Tendesayi Kufa, Derrick P. Smit, Gillian Sorour, Nigel Garrett, Katherine Gill, Lehlohonolo Makhakhe, Nomathemba C. Chandiwana, Neil F. Moran, Karen Cohen, Camilla Wattrus, Mahomed Yunus Moosa
Southern African Journal of HIV Medicine | Vol 25, No 1 | a1577 | DOI: https://doi.org/10.4102/sajhivmed.v25i1.1577 | © 2024 Remco P.H. Peters, Jeremy S. Nel, Eitzaz Sadiq, Tendesayi Kufa, Derrick P. Smit, Gillian Sorour, Nigel Garrett, Katherine Gill, Lehlohonolo Makhakhe, Nomathemba C. Chandiwana, Neil F. Moran, Karen Cohen, Camilla Wattrus, Mahomed Yunus Moosa | This work is licensed under CC Attribution 4.0
Submitted: 15 February 2024 | Published: 30 April 2024

About the author(s)

Remco P.H. Peters, Research Unit, Foundation for Professional Development, East London, South Africa; and Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa; and Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Jeremy S. Nel, Division of Infectious Diseases, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa; and Helen Joseph Hospital, Johannesburg, South Africa
Eitzaz Sadiq, Helen Joseph Hospital, Johannesburg, South Africa; and Department of Neurosciences, Division of Neurology, University of the Witwatersrand, Johannesburg, South Africa
Tendesayi Kufa, Centre for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa; and School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Derrick P. Smit, Division of Ophthalmology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Gillian Sorour, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Nigel Garrett, Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa; and Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
Katherine Gill, Desmond Tutu Health Foundation, Cape Town, South Africa
Lehlohonolo Makhakhe, Department of Dermatology, University of the Free State, Bloemfontein, South Africa; and The South African Institute of Dermatology, Bloemfontein, South Africa
Nomathemba C. Chandiwana, Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Neil F. Moran, KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa; and Department of Obstetrics and Gynaecology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
Karen Cohen, Department of Medicine, Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa
Camilla Wattrus, Southern African HIV Clinicians Society (SAHCS), Johannesburg, South Africa
Mahomed Yunus Moosa, Southern African HIV Clinicians Society (SAHCS), Johannesburg, South Africa; and Department of Infectious Disease, Division of Internal Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

Abstract

Syphilis, ‘the great imitator’, caused by Treponema pallidum infection, remains a complex and multifaceted disease with a rich history of clinical diversity. This guideline aims to be a comprehensive guide for healthcare workers in Southern Africa, offering practical insights into the epidemiology, pathogenesis, clinical manifestations, diagnostic testing, therapeutic principles, and public health responses to syphilis. Although the syphilis burden has declined over the years, recent data indicate a troubling resurgence, particularly among pregnant women and neonates. This guideline highlights the diagnostic challenges posed by syphilis, stemming from the absence of a single high-sensitivity and -specificity test. While treatment with penicillin remains the cornerstone of treatment, alternative regimens may be used for specific scenarios. We highlight the importance of thorough patient follow-up and management of sex partners to ensure optimal care of syphilis cases. In the context of public health, we emphasise the need for concerted efforts to combat the increasing burden of syphilis, especially within high-risk populations, including people living with HIV.


Keywords

syphilis; syphilis treatment; syphilis management; syphilis diagnosis; Treponema pallidum; congenital syphilis; neurosyphilis; ocular syphilis; presumptive syphilis.

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