SYPHILIS – JARISCH-HERXHEIMER REACTION; RETREATMENT
This reaction is a consequence of treponemal destruction. It occurs 6 to 12 hours after commencing treatment and is a mild reaction with fever, headache, malaise, rigors and joint pain. The reaction lasts for several hours and does not recur. Symptoms are controlled by paracetamol and rest.
Only one course of treatment is normally necessary. Further treatment is indicated in the following circumstances:
where clinical symptoms or signs of syphilis persist or recur,
where initially high titres in the reagin test (e.g. VDRL 1/8 or greater or RPR 1/16 or greater) persist for a year or more after treatment; or
where there is a sustained four-fold increase in the titre of the reagin test (as may occur with reinfection in a successfully treated patient).
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