Findings Indicative of Treatment Failure in a Patient Treated for Syphilis

 

Criteria for treatment failure in a patient who has been treated for syphilis:

(1) clinical signs or symptoms of syphilis

(2) persistent (no decline) or rising titer in nontreponemal test (VDRL or RPR) 6 months after therapy

(3) positive PCR test

 

The presence of any of the following results may indicate treatment failure if no explanation can be found:

(1) primary syphilis: positive VDRL or RPR after 12 months

(2) secondary syphilis: positive VDRL or RPR after 24 months

(3) latent syphilis: positive VDRL or RPR after 24 months

(4) late syphilis: positive VDRL or RPR after 5 years (60 months)

 

If there was a problem with therapeutic regimen (inadequate dose, etc) then the patient should be evaluated for treatement failure.

 

If there is no explanation for the treatment failure then the possibility of resistance should be considered.

 

Differential diagnosis:

(1) re-exposure

(2) biological false-positive nontreponemal test