Unless reinfection is likely, lumbar puncture also should be performed. Failure of nontreponemal test titers to decline fourfold by 3 months after therapy for primary or secondary syphilis identifies persons at risk for treatment failure. Those persons should be evaluated for HIV infection. Optimal management of such patients is unclear if they are HIV negative. At a minimum, these patients should have additional clinical and serologic follow-up.
Some experts recommend CSF examination in such situations.
Management of Sex Partners Refer to General Principles, Management of Sex Partners. There is less clinical experience with doxycycline than with tetracycline, but compliance is likely to be better with doxycycline. Therapy for a patient who cannot tolerate either doxycycline or tetracycline should be based upon whether the patient's compliance with the therapy regimen and with follow-up examinations can be assured. For nonpregnant patients whose compliance with therapy and follow-up can be assured, an alternative regimen is erythromycin 500 mg orally 4 times a day for 2 weeks. Various ceftriaxone regimens also may be considered.