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Conditions and Treatments - Antibiotic Prescribing
Eye and Ear
Upper Respiratory
Acute Sinusitis (Adults)
Acute Cough in Children
Otitis Media in Children
Pharyngitis Sore Throat Tonsillitis
Lower Respiratory
Pneumonia and Aspiration Pneumonia in Nursing Homes/Residential Care Facilities
Acute Cough, Bronchitis (Adults)
Bronchiolitis in Children
Acute Cough in Children
Acute Exacerbation of COPD
Community Acquired Pneumonia (Adults)
Community Acquired Pneumonia in Children
COVID -19 Acute Respiratory Infection (Adults)
Azithromycin Prophylaxis in Adults with Respiratory Disease
Influenza
Meningitis
Pregnancy and Postpartum Infections
Prescribing Antimicrobials in Pregnancy and Lactation
Mastitis
Endometritis
Perineal wound infection
C-section wound infection
Nipple and breast thrush
UTI in Pregnancy
Asymptomatic Bacteriuria in Pregnancy
Influenza in Pregnancy
Urinary
Position Statements Dipstick Urinalysis for UTIs in Adults
Deprescribing UTI prophylaxis
Acute Pyelonephritis
Adult Male UTI
Adult Female UTI
UTI in Long Term Care Residents 65 years
Recurrent UTI in Adult, Non-Pregnant Females
UTI in Children
UTI in Pregnancy
Gastro
Infectious Diarrhoea
Threadworms
Traveller's Diarrhoea
Clostridioides difficile
Helicobacter pylori
Genital
Approach to an STI consultation in Primary Care
Acute Prostatitis
Acute Epididymo-orchitis
Bacterial Vaginosis
Chlamydia trachomatis
Gonorrhoea
Pelvic Inflammatory Disease
Trichomoniasis
Candida, Genital Thrush
Anogenital Warts
Syphilis
Genital Herpes
Skin/Soft Tissue
Acne Vulgaris - Antibiotic Prescribing
Animal and Human Bite - Antibiotic Prescribing
Candida - Skin and Oral
Cellulitis
Chickenpox
Conjunctivitis - Antibiotic Prescribing
Dermatophyte Infection Fingernail or Toenail
Dermatophyte Skin Infections
Eczema
Headlice
Hidradenitis Suppurativa - Antibiotic Prescribing
Impetigo
Lyme Disease
Pityriasis versicolor / Tinea versicolor
Rosacea
Scabies
Shingles
Staphylococcal Nasal Carriage
Tinea capitis (scalp ringworm)
Oral/Dental
Dry Socket
Dental prescription guidelines
Angular Cheilitis
Acute Sinusitis
Endocarditis Prophylaxis
Pericoronitis
Dental Guidelines
Periodontal Abscess
Acute Dento-Alveolar Infection
Necrotising Gingivitis
Fungal Infections
Safe Prescribing
Communications from AMRIC
Infection Prevention and Control
Drug Interactions
Hospital Related Guidelines
About us
Prescribing for Children
Conditions and Treatments - Antibiotic Prescribing
Safe Prescribing
Drug Interactions
Hospital Related Guidelines
About us
Antibiotic Prescribing
Conditions and Treatments - Antibiotic Prescribing
Genital
Syphilis
Syphilis, Antibiotic Prescribing
Comments from Expert Advisory Committee
Syphilis is caused by the spirochete
Treponema pallidum
(
T. pallidum
)
Acquired syphilis is commonly transmitted through sexual contact, but can also be transmitted by direct vascular inoculation (IVDU, rarely transfusions) or direct cutaneous contact with infectious lesions. Vertical transmission can occur in utero or in the peripartum period leading to congenital syphilis
Acquired syphilis can be divided into two phases: early and late
Early syphilis is more infectious than late syphilis and is further divided into primary syphilis (chancre); secondary syphilis (systemic phase commonly presenting with a rash) and early latent (asymptomatic within 2 years of acquisition)
Late syphilis can present as late latent infection (asymptomatic greater than 2 years since acquisition); gummatous syphilis; cardiovascular syphilis or neurosyphilis. Symptomatic late syphilis can present 20 to 30 years after acquisition
In Ireland since the 2000’s the majority of early infectious cases of syphilis have been in men who have sex with men (MSM). There have been concerns more recently regarding an increase in cases of syphilis among the heterosexual population. Syphilis testing is indicated in all sexually active MSM presenting with an anogenital ulcer or generalised rash and should be offered to all MSM requesting STI testing or considered to be at risk of STIs.
Congenital syphilis is uncommon in Ireland and preventable with antenatal screening and appropriate maternal and neonatal management. All women should be offered syphilis testing at antenatal booking
The screening test for syphilis is
T. pallidum
EIA (enzyme immunoassay) which checks for antibodies to
T. pallidum.
In individuals with syphilis, this test remains positive regardless of treatment or risk of reinfection
Parenteral penicillin is first line treatment. Patients with newly diagnosed syphilis should be referred to a GUM clinic for further management and treatment
Individuals diagnosed with syphilis should be offered testing for other STIs including HIV, Hepatitis B, chlamydia and gonorrhoea.
Hepatitis C testing
should be considered part of routine sexual health screening in the following circumstances: MSM, People living with HIV; Commercial sex workers; People who inject drugs (PWID); Partners of the above should also be considered for HCV testing.
Partner notification is an important part of the management of early syphilis and is best done within a specialist sexual health clinic.
Patients with newly diagnosed syphilis should be referred to a GUM clinic for management and treatment.
Syphilis is a notifiable disease.
Notification process is usually initiated by the testing laboratory.
Treatment options
Parenteral penicillin – the dose, duration and route (IV versus IM) is determined by the clinical circumstances
Oral doxycycline – the dose and duration is determined by the clinical circumstances
Decisions around treatment should be made by a clinician with expertise and experience in managing syphilis
Patient information
Patient information on STIs and genital conditions is available at the HSE Sexual Health and Crisis Pregnancy website
Information for MSM on sexual health is available at the Man2Man website
Safe Prescribing
(visit the safe prescribing page)
Visit the
Health Products Regulatory Authority (HPRA) website
for detailed drug information (summary of product characteristics and patient information leaflets). Dosing details, contraindications and drug interactions can also be found in the Irish Medicines Formulary (IMF) or other reference sources such as British National Formulary (BNF) / BNF for children (BNFC).
Reviewed June 2021
Conditions and Treatments - Antibiotic Prescribing
Eye and Ear
Upper Respiratory
Lower Respiratory
Influenza
Meningitis
Pregnancy and Postpartum Infections
Urinary
Gastro
Genital
Approach to an STI consultation in Primary Care
Acute Prostatitis
Acute Epididymo-orchitis
Bacterial Vaginosis
Chlamydia trachomatis
Gonorrhoea
Pelvic Inflammatory Disease
Trichomoniasis
Candida, Genital Thrush
Anogenital Warts
Syphilis
Genital Herpes
Skin/Soft Tissue
Oral/Dental
Safe Prescribing
Infection Prevention and Control
Drug Interactions
Hospital Related Guidelines
About us
Prescribing for Children