Healthcare Providers

In the past several years the incidence of syphilis increased dramatically in Virginia and nationally. Between 2019 and 2023, the rate of total early syphilis in Virginia increased 37%. We have also observed dramatic increases in the incidence of congenital syphilis, a preventable diagnosis with potentially severe consequences for infected infants. Clinicians and allied health professionals represent our first line of defense in detecting syphilis. Please help us identify and reduce the spread of syphilis in Virginia.

Conduct a full sexual health history for all patients.

Screen for syphilis in all patients aged 15-44 years who are sexually active and living in a county with high incidence of syphilis, in keeping with CDC recommendations to prevent cases of congenital syphilis.  For all other counties, continue to assess risk factors to recommend testing.  Test all symptomatic patients for syphilis, regardless of their risk factors or where they live.

In keeping with updated recommendations from the American College of Obstetricians and Gynecologists (ACOG), serologically screen all pregnant persons at their first prenatal care visit, followed by universal rescreening early in the third trimester (28-32 weeks) and again at delivery, regardless of risk.

Order both treponemal and nontreponemal serologic tests to detect active syphilis infection (ex: reflex RPR and TPPA, or EIA reflex to RPR reflex to TPPA). The results of these tests can be used in combination with signs and symptoms in the last 12 months to differentiate between early or late syphilis infection.  Ordering only one of these tests may delay identification and treatment of an active infection.

Stage cases of syphilis and consider syphilis for your differential diagnosis, as it can mimic many other conditions. Syphilis has four stages: primary, secondary, latent, and tertiary.  Each stage has different signs and symptoms.  The earlier stages are considered the most infectious.  Ocular, otic and neurological manifestations of syphilis can occur at any stage.
- Refer to the CDC STD Treatment Guidelines for syphilis for full details on the recommended treatment regimen for each syphilis stage.
- Benzathine penicillin G in a regimen appropriate for the stage of infection is the only recommended treatment for syphilis during pregnancy. Patients who are allergic to penicillin must be desensitized and treated with benzathine penicillin G.
- Pregnant women diagnosed with late syphilis must be treated with 3 doses 7 days apart. Pregnant women who miss any doses must repeat the full course of therapy.

Everyone who tests positive for syphilis should also receive an HIV test unless their HIV positive status is already documented. All syphilis patients who are HIV negative should be offered Pre-Exposure Prophylaxis for HIV (PrEP).

Consider prescribing Doxycycline as post-exposure prophylaxis (DoxyPEP) for syphilis for patients who are clinically indicated.

Report syphilis diagnoses to your local health department as soon as possible.
Inform your patients diagnosed with syphilis that the health department will contact them to offer follow-up counseling and confidential partner services.
- Disease Intervention Specialists (DIS) are public health staff who are trained to follow up with partners and offer testing and treatment services. They can also assist with the staging of syphilis diagnoses.
- It is important that all partners of patients diagnosed with syphilis are also tested and treated to prevent reinfections and further transmission.