Syphilis Treatment: Slow Progress and Lymph Node Concerns

Q: Syphilis Treatment: Slow Progress and Lymph Node Concerns

Dear readers： <br>1. <br><Is the decrease in index a bit slow?> <br>A： If it is a first-time infection and treatment is received within a year, the index does indeed decrease somewhat slowly. <br>If it is a reinfection (more than twice) with an increase of fourfold or more, it ca

Syphilis treatment

Last November, I was diagnosed with syphilis with a titer of 1:256.
I received one injection and took tetracycline for 21 days.
During this week's follow-up, the titer is still at 1:128, which seems to be decreasing slowly.
Therefore, I received another injection this week.
Is this rate of decrease considered slow? Since I work abroad, I can only get tested every three months.
Additionally, I recently noticed that the lymph nodes in my neck seem to have enlarged.
Should I change my treatment approach? Thank you.

Niming, 30~39 year old female. Ask Date: 2019/03/15

Dr. Liao Zhongxin reply Internal Medicine

Dear readers:
1.

A: If it is a first-time infection and treatment is received within a year, the index does indeed decrease somewhat slowly.
If it is a reinfection (more than twice) with an increase of fourfold or more, it can be considered acceptable, but protective measures should still be diligently maintained, and blood tests should be monitored.
2.

A: First and foremost, safe sexual practices remain the most important, which includes using condoms and having a stable sexual partner, while avoiding drug use.
Secondly, symptoms can vary from person to person.
Regarding treatment, standard therapy with penicillin is preferable, and it is advisable to discuss the changes in index and treatment options with a clinical physician.
Thank you!

Reply Date: 2019/03/15

More Info

Thank you for your question regarding the treatment of syphilis and your concerns about the slow progress in your treatment and the enlargement of your lymph nodes.
Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. The treatment typically involves antibiotics, with penicillin being the most common and effective choice. In your case, it seems that you have been treated with tetracycline, which is also effective but may not be the first-line treatment for syphilis. The serological response to treatment can vary among individuals, and it is not uncommon for some patients to experience a slower decline in their titers.

The fact that your titers have decreased from 1:256 to 1:128 indicates that the treatment is having some effect, but the rate of decline may be slower than expected. In general, a fourfold decrease in titers (for example, from 1:256 to 1:64) is considered a good response to treatment within a few months. However, individual responses can vary based on several factors, including the stage of syphilis at diagnosis, the individual's immune response, and the specific antibiotic used.

Regarding your concern about the enlarged lymph nodes, this can be a sign of ongoing infection or inflammation. In syphilis, lymphadenopathy (swollen lymph nodes) can occur during the primary and secondary stages of the disease. If your lymph nodes are persistently enlarged, tender, or accompanied by other symptoms such as fever, it is essential to discuss this with your healthcare provider. They may consider further evaluation to rule out other potential causes of lymphadenopathy, including other infections or conditions.

Given that you are only able to have follow-up appointments every three months due to your work situation, it is crucial to maintain open communication with your healthcare provider. If you notice any new symptoms or if your lymph nodes continue to enlarge, it may be necessary to adjust your treatment plan. Your doctor may consider switching to a different antibiotic, such as benzathine penicillin G, which is the preferred treatment for syphilis and is typically administered as an intramuscular injection.

In summary, while your current treatment appears to be having some effect, the rate of decline in your titers may be slower than expected. The enlargement of your lymph nodes warrants further evaluation. It is essential to keep your healthcare provider informed about your symptoms and any changes you notice. They can provide guidance on whether a change in treatment is necessary and help monitor your progress effectively.
If you have any further questions or concerns, please do not hesitate to reach out to your healthcare provider for personalized advice and support.

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