Interventions for Syphilis

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Age Cohort: Pregnancy and newborn

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Social and behavioural change communication for parents Community awareness on the risks and prevention of sexual abuse of children	Primary prevention of syphilis in adolescents and women of child bearing ages Safe sexual practice including condom use Onsite rapid syphilis screening during routine antenatal care	Recognition of syphilis signs and symptoms Syphilis RDT	Referral to the next higher level Onsite rapid syphilis screening and treatment with a single dose of benzathine penicillin into routine antenatal care		Emotional, social, spiritual support for parents
Primary Care
Education for high risk reproductive age women on regular condom use with non-regular partners VDRL or RPR Testing for all pregnant women Pregnant women with positive VDRL or RPR test should have the FTA test	Safe blood transfusion Early syphilis screening and treatment of women	History Physical examination Treponemal test Non-treponemal rapid plasma reagin (RPR) test Syphilis testing of mother	Antibiotics Referral to the next higher level Onsite rapid syphilis screening and treatment with a single dose of benzathine penicillin into routine antenatal care		Emotional, social, spiritual support for parents
Referral Facility: General
Education for high risk reproductive age women on regular condom use with non-regular partners VDRL or RPR Testing for all pregnant women Pregnant women with positive VDRL or RPR test should have the FTA test	Safe blood transfusion Screening pregnant women for syphilis Treatment of syphilis in pregnant women	History Physical examination Treponemal test Non-treponemal rapid plasma reagin (RPR) test Syphilis testing of mother X-ray	Antibiotics Referral to the next higher level for corrective surgery Onsite rapid syphilis screening and treatment with a single dose of benzathine penicillin into routine antenatal care	Treatment with PenicillinTreatment of sex partners	Emotional, social, spiritual support for parents
Referral Facility: Specialist
Education for high risk reproductive age women on regular condom use with non-regular partners VDRL or RPR Testing for all pregnant women Pregnant women with positive VDRL or RPR test should have the FTA test	Safe blood transfusion Screening pregnant women for syphilis Treatment of syphilis in pregnant women	History Physical examination Treponemal test Non-treponemal rapid plasma reagin (RPR) test Lumbar puncture for CSF analysis X-ray Histological examination of the placenta and cord	Examination and reaginic tests of treated clients at 3, 6 and 12 months and annually until test is non-reactive Screening of high risk women for sexually transmitted infections Onsite rapid syphilis screening and treatment with a single dose of benzathine penicillin into routine antenatal care	Treatment with PenicillinTreatment of sex partners

Age Cohort: 5 - 11 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Education of parents on the risks and prevention of sexual abuse of children			Home based supervision of girls with confirmed Syphilis infection to comply with treatment and follow-up instructions
Primary Care
	Screening of girls for evidence of sexual abusGirls with evidence of sexual abuse should be screened for sexually transmitted infections Test is non-reactiveGirls with positive VDRL or RPR test should have the FTA test Examination and reaginic tests of treated clients at 3, 6 and 12 months and annually until		Refer suspected cases of neurosyphilis to hospital for further investigation and treatment Treatment with Penicillin
Referral Facility: General
	Screening of girls for evidence of sexual abuse Girls with evidence of sexual abuse should be screened for sexually transmitted infections Girls with positive VDRL or RPR test should have the FTA testExamination and reaginic tests of treated clients at 3, 6 and 12 months and annually until test is non-reactive For neurosyphilis, CSF testing every 6 months until CSF cell count is normal		Treatment with Penicillin
Referral Facility: Specialist
	Screening of girls for evidence of sexual abuse Girls with evidence of sexual abuse should be screened for sexually transmitted infections Girls with positive VDRL or RPR test should have the FTA test Examination and reaginic tests of treated clients at 3, 6 and 12 months and annually until test is non-reactive For neurosyphilis, CSF testing every 6 months until CSF cell count is normal		Treatment with Penicillin

Age Cohort: 12 - 24 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Adolescent centered education on delaying sexual debut and safe sex practices School-based education on sexuality and safe sex practices Education on symptoms of sexually transmitted infections and what to do in the event of occurrence of symptoms	Adolescent centered education on delaying sexual debut and safe sex practices School-based education on sexuality and safe sex practicesEducation on symptoms of sexually transmitted infections and what to do in the event of occurrence of symptoms Screening of female adolescents for sexual abuse during home visits by Community Health Workers Referral of suspected cases of sexual abuse to appropriate authorities		Home based supervision of adolescents with confirmed Syphilis infection to comply with treatment and follow-up instructions Referral of adolescents with genital ulcers for syphilis screening	Physiotherapy support for people with residual neurological effects of neurosyphilis	Pain relief with non-opioid analgesics for patients with late or tertiary syphilis
Primary Care
	Men and women with genital ulcers should have VDRL Test Men and women with positive VDRL or RPR test should have the FTA test Screening of high risk women for sexually transmitted infections		Refer suspected cases of neurosyphilis to hospital for further investigation and treatment Treatment ofTreatment with Penicillinex partners	Physiotherapy support for people with residual neurological effects of neurosyphilis	Pain relief with non-opioid analgesics for patients with late or tertiary syphilis
Referral Facility: General
	Examination and reaginic tests of treated clients at 3, 6 and 12 months and annually until test is non-reactive Screening of high risk women for sexually transmitted infectionsMen and women with genital ulcers should have VDRL Test Men and women with positive VDRL or RPR test should have the FTA test. For neurosyphilis, CSF testing every 6 months until CSF cell count is normal		Treatment with PenicillinTreatment of sex partners	Specialist care for people with cardiovascular and other systemic residual effects of syphilis Specialist physiotherapy and neurology care for people with residual neurologic effects of neurosyphilis	Pain relief with opioid and non-opioid analgesics for patients with late or tertiary syphilis
Referral Facility: Specialist
	Examination and reaginic tests of treated clients at 3, 6 and 12 months and annually until test is non-reactive Screening of high risk women for sexually transmitted infections Men and women with genital ulcers should have VDRL Test Men and women with positive VDRL or RPR test should have the FTA test. For neurosyphilis, CSF testing every 6 months until CSF cell count is normal		Treatment with PenicillinTreatment of sex partners	Specialist care for people with cardiovascular and other systemic residual effects of syphilis Specialist physiotherapy and neurology care for people with residual neurologic effects of neurosyphilis	Pain relief with opioid and non-opioid analgesics for patients with late or tertiary syphilis

Age Cohort: 25 - 59 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Education on symptoms of sexually transmitted infections and what to do in the event of occurrence of symptoms General public education on condom use and maintaining one sexual partner	Education on symptoms of sexually transmitted infections and what to do in the event of occurrence of symptoms General public education on condom use and maintaining one sexual partner		Home based supervision of men and women with confirmed Syphilis infection to comply with treatment and follow-up instructions Referral of men and women with genital ulcers for syphilis screening	Physiotherapy support for people with residual neurological effects of neurosyphilis	Pain relief with non-opioid analgesics for patients with late or tertiary syphilis
Primary Care
	Examination and reaginic tests of treated clients at 3, 6 and 12 months and annually until test is non-reactive Men and women with genital ulcers should have VDRL Test Men and women with positive VDRL or RPR test should have the FTA test Screening of high risk women for sexually transmitted infections		Treatment with Penicillin Treatment of sex partners Refer suspected cases of neurosyphilis to hospital for further investigation and treatment	Physiotherapy support for people with residual neurological effects of neurosyphilis	Pain relief with non-opioid analgesics for patients with late or tertiary syphilis
Referral Facility: General
	Examination and reaginic tests of treated clients at 3, 6 and 12 months and annually until test is non-reactive Men and women with genital ulcers should have VDRL Test Men and women with positive VDRL/RPR test should have the FTA For neurosyphilis, CSF testing every 6 months until CSF cell count is normal Screening of high risk women for sexually transmitted infections		Treatment with PenicillinTreatment of sex partners	Specialist care for people with cardiovascular and other systemic residual effects of syphilis Specialist physiotherapy and neurology care for people with residual neurologic effects of neurosyphilis	Pain relief with opioid and non-opioid analgesics for patients with late or tertiary syphilis
Referral Facility: Specialist
	Examination and reaginic tests of treated clients at 3, 6 and 12 months and annually until test is non-reactive Men and women with genital ulcers should have VDRL Test Men and women with positive VDRL/RPR test should have the FTAFor neurosyphilis, CSF testing every 6 months until CSF cell count is normal Screening of high risk women for sexually transmitted infections		Treatment with PenicillinTreatment of sex partners	Specialist care for people with cardiovascular and other systemic residual effects of syphilis Specialist physiotherapy and neurology care for people with residual neurologic effects of neurosyphilis	Pain relief with opioid and non-opioid analgesics for patients with late or tertiary syphilis

Age Cohort: 60+ years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Education on symptoms of sexually transmitted infections and what to do in the event of occurrence of symptoms General public education on condom use and maintaining one sexual partner	Education on symptoms of sexually transmitted infections and what to do in the event of occurrence of symptoms General public education on condom use and maintaining one sexual partne		Home based supervision of men and women with confirmed Syphilis infection to comply with treatment and follow-up instructions Referral of men and women with genital ulcers for syphilis screening	Physiotherapy support for people with residual neurological effects of neurosyphilis	Pain relief with non-opioid analgesics for patients with late or tertiary syphilis
Primary Care
	Examination and reaginic tests of treated clients at 3, 6 and 12 months and annually until test is non-reactive Men and women with genital ulcers should have VDRL Test Men and women with positive VDRL or RPR test should have the FTA test		Treatment with PenicillinTreatment of sex partners Refer suspected cases of neurosyphilis to hospital for further investigation and treatment	Physiotherapy support for people with residual neurological effects of neurosyphilis	Pain relief with non-opioid analgesics for patients with late or tertiary syphilis
Referral Facility: General
	Men and women with genital ulcers should have VDRL Test Men and women with positiveVDRL or RPR test should have the FTA test Examination and reaginic tests of treated clients at 3, 6 and 12 months and annually until test is non-reactive For neurosyphilis, CSF testing every 6 months until CSF cell count is normal		Treatment with PenicillinTreatment of sex partners	Specialist care for people with cardiovascular and other systemic residual effects of syphilis Specialist physiotherapy and neurology care for people with residual neurologic effects of neurosyphilis	Screening of children for sexual abuse during home visits by Community Health Workers Pain relief with opioid and non-opioid analgesics for patients with late or tertiary syphilis Referral of children suspected to be victims of sexual abuse to the next level for examination and needed treatment Referral of suspected cases of sexual abuse to appropriate authorities
Referral Facility: Specialist
	Men and women with genital ulcers should have VDRL Test Men and women with positiveVDRL or RPR test should have the FTA test Examination and reaginic tests of treated clients at 3, 6 and 12 months and annually until test is non-reactive For neurosyphilis, CSF testing every 6 months until CSF cell count is normal		Treatment with PenicillinTreatment of sex partners	Specialist care for people with cardiovascular and other systemic residual effects of syphilis Specialist physiotherapy and neurology care for people with residual neurologic effects of neurosyphilis	Screening of children for sexual abuse during home visits by Community Health Workers Pain relief with opioid and non-opioid analgesics for patients with late or tertiary syphilis Referral of children suspected to be victims of sexual abuse to the next level for examination and needed treatment Referral of suspected cases of sexual abuse to appropriate authorities

Age Cohort: < 5 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Social and behavioural change communication for parents Community awareness on the risks and prevention of sexual abuse of children	Primary prevention of syphilis in adolescents and women of child bearing ages Safe sexual practice including condom use	Recognition of syphilis signs and symptoms Syphilis RDT	Referral to the next higher level		Emotional, social, spiritual support for parents
Primary Care
	Safe blood transfusion Early syphilis screening and treatment of women	History Physical examination Treponemal test Non-treponemal rapid plasma reagin (RPR) test Syphilis testing of mother	Antibiotics Referral to the next higher level	Physiotherapy, speech therapy services Training on use of assisting devices	Emotional, social, spiritual support for parents
Referral Facility: General
	Safe blood transfusion Screening pregnant women for syphilis Treatment of syphilis in pregnant women	History Physical examination Treponemal test Non-treponemal rapid plasma reagin (RPR) test Syphilis testing of mother 8 X-ray	Antibiotics Referral to the next higher level for corrective surgery	Physiotherapy, speech therapy services Training on use of assisting devices	Emotional, social, spiritual support for parents
Referral Facility: Specialist
	Safe blood transfusion Screening pregnant women for syphilis Treatment of syphilis in pregnant women	History Physical examination Treponemal test Non-treponemal rapid plasma reagin (RPR) test Lumbar puncture for CSF analysis X-ray Histological examination of the placenta and cord	Antibiotics Surgical repair of deformity	Physiotherapy, speech therapy services Training on use of assisting devices	Emotional, social, spiritual support for parents