A non-treponemal test (RPR or VDRL) for screening
A treponemal test (FTA-abs, MHA-TP, or TPPA) for confirmation if non-treponemal test positive, as non- treponemal tests have frequent false positives
Diagnosis of syphilis can be very complex. Contact an infectious disease specialist or your local health department for support and advice. In Milwaukee, physicians and other health professionals are invited to call the Milwaukee Health Department Sexually Transmitted Disease program at 414-286-5526.
ELISA, with Western Blot (WB) if ELISA positive, or
OraSure or OraQuick, but must confirm with ELISA and WB if positive
State law requires reporting known or suspected cases of chlamydia, gonorrhea, and syphilis (among many other reportable diseases) to your local public health dept. within 72 hours. Demographic and treatment information is essential to facilitate appropriate public health follow-up and thereby impact overall disease rates. In southeastern Wisconsin report forms can be sent by US mail, or faxed to 414-286-8172 - - for assistance call 414-286-5526.
HIV must be reported within 72 hours to the state epidemiologist in Madison, per state law.
Any person with gonorrhea or with a history of sexual contact with a known case of gonorrhea should be treated with one of the following antigonorrheal antibiotics:
Ceftriaxone 125 mg IM in a single dose, or
Cefixime 400mg PO in a single dose, or
Cefpodoxime 400mg PO in a single dose, or
Cefuroxime axetil 1g PO in a single dose, or
ceftizoxime 500mg IM in a single dose, or
cefotaxime 500mg IM in a single dose, or
spectinomycin 2g IM in a single dose (if allergic to cephalosporins)
For pharyngeal gonorrhea, only ceftriaxone is recommended.
Do not use quinolones, or azithromycin 2g, for gonococcal infections, per CDC’s 2007 recommendations. Quinolone-resistant gonorrhea is rapidly increasing nationwide and in Milwaukee, and there is increasing risk for development of macrolide-resistant gonorrhea as well.
Cefixime, cefpodoxime, and spectinomycin may have limited availability. See http://www.cdc.gov/std/gonorrhea/arg for details.
Test of cure is generally not needed after completing one of the recommended regimens (even for pregnant women) unless symptoms present before treatment fail to resolve.
Concomitant treatment for chlamydia must be given as well, unless chlamydia has been ruled out by laboratory testing, because of high rates of co-infection.
Any person with chlamydia or with a history of sexual contact to a known case of chlamydia should be treated with one of the following preferred antichlamydial antibiotics:
Azithromycin 1 g orally in a single dose, or
Doxycycline 100 mg orally twice a day for 7 days
If unable to use a preferred regimen, use:
Erythromycin base 500 mg orally four times a day for 7 days, or
Erythromycin ethylsuccinate 800 mg orally four times a day for 7 days, or
Ofloxacin 300 mg orally twice a day for 7 days, or
Levofloxacin 500 mg orally for 7 days
Azithromycin is pregnancy category B (no evidence of fetal harm in animal studies) thus acceptable for use to treat chlamydia in pregnant women.
STD SCREENING, TESTING AND TREATMENT GUIDELINES FOR HIGH PREVALENCE AREAS Approved 11/4/03 by the MSMC Community Collaboration on Healthcare Quality & the City of Milwaukee Health Department
Treatment for Gonorrhea Updated 1/21/08
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