Management

• intramuscular benzathine penicillin is the first-line management
• alternatives: doxycycline
• nontreponemal (rapid plasma reagin [RPR] or Venereal Disease Research Laboratory [VDRL]) titres should be monitored after treatment to assess the response
  • a fourfold decline in titres (e.g. 1:16 → 1:4 or 1:32 → 1:8)is often considered an adequate response to treatment
• the Jarisch-Herxheimer reaction is sometimes seen following treatment
  • fever, rash, tachycardia after the first dose of antibiotic
  • in contrast to anaphylaxis, there is no wheeze or hypotension
  • it is thought to be due to the release of endotoxins following bacterial death and typically occurs within a few hours of treatment
  • no treatment is needed other than antipyretics if required