Monitoring
Nontreponemal tests are repeated to monitor active infection and treatment response. Titers should generally decline fourfold within 12 months after treatment of primary or secondary syphilis and within 24 months after treatment of latent or late syphilis.[8][33]
Venereal Disease Research Laboratory or rapid plasma reagin titers should be measured monthly after treatment for 3 months, and then every 3 months thereafter. The same nontreponemal test should be used sequentially when monitoring treatment response.[32] This is because results obtained from one test are not directly comparable with that of the other, nontreponemal test.
With effective treatment, nontreponemal tests should become negative. However, some patients who have received adequate treatment become serofast, maintaining a low-level positive titer. This is their baseline titer from which reinfection is assessed.
There are no data to suggest a benefit to performing repeat cerebrospinal fluid examination in immunocompetent patients, or in patients with HIV who are on antiretroviral treatment, if serologic and clinical responses are observed after the treatment for neurosyphilis.[8]
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