2019 Chinese expert consensus statement on diagnosis and treatment of syphilis.

Syphilis, caused by Treponema pallidum subsp pallidum (T. pallidum), is a chronic, systemic human disease transmitted through sexual contact. The incidence and prevalence of syphilis is still high in China.[ To guide the prevention measures and management of this disease, we renew the guidelines on diagnosis and treatment of syphilis [Supplementary file]. Manifestations and diagnosis of all stages of syphilis are presented in Table 1, and management in Table 2.

Table 1

Manifestations and diagnosis of all stages of syphilis.

Table 2

Managements of all stages of syphilis.

In addition, after recommended treatment, regular follow-up should be performed, including clinical and serological evaluation. The assessment criteria of effective treatment include disappear of the skin lesion and clinical symptoms, and the titer of a non-treponemal serological test (NTT) should decline by more than or equal to four-fold within 3 to 6 months after treatment. If the NTT reverts from negative to positive or the titer is increased by four-fold, it is defined as serological reactivation. If clinical symptoms reappear (usually accompanied by increased NTT titer), it is defined as clinical reactivation. All patients with serological or clinical reactivation should receive treatment again. In a few syphilis patients, the titer of NTT may decline, but it usually does not return to negative, and remain positive within certain period (even through life), in which case, defined as serofast.

The Expert Group members:

Rui-Li Zhang1, Qian-Qiu Wang2, Yue-Ping Yin2, Quan-Zhong Liu3, Shu-Zhen Qi2, Dong-Mei Xu4, Yu-Ye Li5, Xiao-Fang Li2, Xiao-Hong Su2, Min-Zhi Wu6, Xian-Biao Zou7, Li-Gang Yang8, Xiang-Sheng Chen2, Ping-Yu Zhou9, Jin-Hua Xu10, Xiang-Dong Gong2, Guo-Jun Liang2, Juan Jiang2, Hao Cheng11, Feng-Qin Ge2

1 Department of Dermatology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210011, China

2 Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College, National Center for Sexually Transmitted Disease Control, China Centers for Disease Control and Prevention, Nanjing, Jiangsu 210042, China.

3 Department of Dermatology, General Hospital of Tianjin Medical University, Tianjin 300052, China

4 Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China

5 Department of Dermatology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China

6 Department of Dermatology, The 5th People's Hospital of Suzhou, Suzhou, Jiangsu 215131, China

7 Department of Dermatology, The First Affiliated Hospital of General Hospital of People's Liberation Army, Beijing 100037, China

8 Department of Dermatology, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong 510091, China

9 Department of Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai 200071, China

10 Department of Dermatology, Huashan Hospital of Fudan University, Shanghai 200040, China

11 Department of Dermatology, Sir Run Run Shaw Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China

Funding

This work was supported by grants from the Union Innovation Team Project of the Chinese Academy of Medical Sciences (No. 2016-I2M-3021), and the National Natural Science Foundation of China (Nos. 81772209, 81601804).

Conflicts of interest

None.