A 47-year-old man is clinically diagnosed with secondary syphilis and treated with benzathine penicillin G 2.4 million units intramuscular (IM) in a single dose. The lab test results return with a positive syphilis enzyme immunoassay (EIA) and a positive Rapid Plasma Reagin (RPR) at a titer of 1:256. The HIV-1/2 antigen-antibody test is negative. At a follow-up visit in 6 months, no new symptoms have developed and RPR testing reveals a titer of 1:32.
What would you recommend as the next course of action regarding management of syphilis for this man?
Figure 1. Nontreponemal Syphilis Titers
In this example, sample 1= baseline RPR titer and sample 2 = follow-up RPR titer
Source: illustration by David H. Spach, MD
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Question Last Updated
February 4th, 2025
February 4th, 2025
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