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Darcy A. Wooten, MD

Darcy A. Wooten, MD

Professor of Medicine; ID Fellowship Program Director

Washington University

St Louis, MO

131 Steuart St, Suite 500, San Francisco, CA 94105

Phone: (415) 544-9400 | info@iasusa.org

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CROI
Conference on Bacteriophages
RWHAP Clinical Conference
Podcasts
Slides
Question of the Week
Donate
Contact
CME Courses
CME Webinars
Dialogues
Topics In Antiviral Medicine
HIV Drug Resistance
Fellow Resources
About

Practice Question of the Week

May 5, 2025: Preventing and Managing Syphilis

A 46-year-old man with HIV (plasma HIV RNA <20 copies/mL; CD4+ count, 1100 cells/µL) presented to care with low-grade fever, hair loss, and a rash involving his palms and soles. His treponemal enzyme immunoassay was reactive, as was his serum rapid plasma reagin (RPR) with a titer of 1:64. He was diagnosed with secondary syphilis and treated with 2.4 million units of long-acting benzathine penicillin G intramuscularly. At 3 months, his RPR titer was 1:32. Now, at 6 months, his RPR titer is still 1:32. He denies any symptoms or new exposures since his treatment 6 months ago. Which of the following is the most appropriate approach at 6 months following treatment for early syphilis?
- A. No intervention is necessary at this time. Continue to follow the RPR titers
- B. Order a cerebrospinal fluid examination (ie, lumbar puncture)
- C. Treat with 1 intramuscular dose of 2.4 million units of long-acting benzathine penicillin G
- D. Treat with 3 intramuscular doses of 2.4 million units of long-acting benzathine penicillin G, each 1 week apart

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