Prognosis
Natural course of infection
Treatment is curative once antibiotic treatment is completed. However, reinfection may occur if there is further exposure to syphilis.
The natural course of organ-specific involvement is determined by the stage of syphilis at diagnosis and whether appropriate treatment has been administered. Follow-up of organ-specific complications requires specialist opinion (e.g., cardiology assessment of aortic regurgitation; neurology assessment of tabes dorsalis).
Serology test results
Treponemal-specific tests remain reactive lifelong; therefore, they are unable to differentiate between current (active) and past infections. Nor can they be used to monitor response to treatment.
Patients should be informed that future treponemal-specific testing will reveal previously treated syphilis infection.
Nontreponemal tests show a decline in titers or become nonreactive (negative) with effective treatment and are, therefore, used as a quantitative marker of 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]
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