{"id":4244,"date":"2021-10-08T08:00:00","date_gmt":"2021-10-08T01:00:00","guid":{"rendered":"https:\/\/drsoaraweeurology.com\/?p=4244"},"modified":"2026-08-22T05:21:08","modified_gmt":"2026-08-21T22:21:08","slug":"%eb%a7%a4%eb%8f%85-%ec%98%ac%eb%b0%94%eb%a5%b8-%eb%b0%a9%eb%b2%95-%ec%b2%98%eb%a6%ac","status":"publish","type":"post","link":"https:\/\/drsoaraweeurology.com\/ko\/2021\/10\/08\/syphilis-correct-way-deal-with\/","title":{"rendered":"\ub9e4\ub3c5 \uce58\ub8cc: \uce58\ub8cc \ubc29\ubc95 \ubc0f \uce58\ub8cc \ud6a8\uacfc \ud655\uc778 \ubc29\ubc95"},"content":{"rendered":"\n<div class=\"wp-block-columns coblocks-author-columns has-background is-layout-flex wp-container-core-columns-is-layout-52275889 wp-block-columns-is-layout-flex\" style=\"background-color:#8C8C971A;padding-top:2.5rem;padding-right:2.5rem;padding-bottom:2.5rem;padding-left:2.5rem\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:25%\">\n<figure class=\"wp-block-image size-full is-style-rounded\"><img data-recalc-dims=\"1\" fetchpriority=\"high\" decoding=\"async\" width=\"800\" height=\"800\" data-attachment-id=\"7037\" data-permalink=\"https:\/\/drsoaraweeurology.com\/ko\/new-photo-2024\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?fit=800%2C800&amp;ssl=1\" data-orig-size=\"800,800\" data-comments-opened=\"1\" data-image-title=\"Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?fit=800%2C800&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=800%2C800&#038;ssl=1\" alt=\"Best Urologist working in Chonburi and Cambodia\" class=\"wp-image-7037\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?w=800&amp;ssl=1 800w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=300%2C300&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=150%2C150&amp;ssl=1 150w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=768%2C768&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=12%2C12&amp;ssl=1 12w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=600%2C600&amp;ssl=1 600w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=400%2C400&amp;ssl=1 400w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=200%2C200&amp;ssl=1 200w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:75%\">\n<p class=\"wp-block-paragraph\"><strong><a href=\"https:\/\/drsoaraweeurology.com\/\" target=\"_blank\" rel=\"noreferrer noopener\">Soarawee Weerasopone, Urologist<\/a><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\" target=\"_blank\" rel=\"noreferrer noopener\">Bangkok hospital Headquarter, Bangkok<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"tel:+66880221445\" target=\"_blank\" rel=\"noreferrer noopener\">Samitivej Sriracha Hospital \u2014 Urology department: <strong>088-022-1445<\/strong><\/a><\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button is-style-outline is-style-outline--1\"><a class=\"wp-block-button__link has-background-background-color has-text-color has-background has-link-color has-small-font-size has-custom-font-size wp-element-button\" href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\" style=\"color:#1b4965\" target=\"_blank\" rel=\"noreferrer noopener\">Book a Consultation<\/a><\/div>\n<\/div>\n<\/div>\n<\/div>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<ul class=\"wp-block-social-links aligncenter has-normal-icon-size is-style-default coblocks-animate is-content-justification-center is-layout-flex wp-container-core-social-links-is-layout-3e41869c wp-block-social-links-is-layout-flex\"><li class=\"wp-social-link wp-social-link-wordpress wp-block-social-link\"><a href=\"https:\/\/drsoaraweeurology.com\/\" class=\"wp-block-social-link-anchor\"><svg width=\"24\" height=\"24\" viewBox=\"0 0 24 24\" 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 title=\"ORCID iD\"\n     aria-label=\"View ORCID Profile\"\n     style=\"text-decoration: none; color: #A6CE39; transition: transform 0.2s; display: inline-block;\"\n     onmouseover=\"this.style.transform='scale(1.15)'\"\n     onmouseout=\"this.style.transform='scale(1)'\">\n    <svg width=\"28\" height=\"28\" viewBox=\"0 0 24 24\" fill=\"currentColor\">\n      <path d=\"M12 0C5.372 0 0 5.372 0 12s5.372 12 12 12 12-5.372 12-12S18.628 0 12 0zM7.369 4.378c.525 0 .947.431.947.947 0 .525-.422.947-.947.947-.525 0-.946-.422-.946-.947 0-.525.421-.947.946-.947zm-.722 3.038h1.444v10.041H6.647V7.416zm3.562 0h3.9c3.712 0 5.344 2.653 5.344 5.025 0 2.578-2.016 5.025-5.325 5.025h-3.919V7.416zm1.444 1.303v7.444h2.297c3.272 0 4.022-2.484 4.022-3.722 0-2.016-1.284-3.722-4.097-3.722h-2.222z\"\/>\n    <\/svg>\n  <\/a>\n  \n  <a href=\"https:\/\/scholar.google.com\/citations?user=lTgsRMUAAAAJ&#038;hl=en\" \n     target=\"_blank\" \n     rel=\"noopener\"\n     title=\"Google Scholar\"\n     aria-label=\"View Google Scholar Profile\"\n     style=\"text-decoration: none; color: #4285F4; transition: transform 0.2s; display: inline-block;\"\n     onmouseover=\"this.style.transform='scale(1.15)'\"\n     onmouseout=\"this.style.transform='scale(1)'\">\n    <svg width=\"28\" height=\"28\" viewBox=\"0 0 24 24\" fill=\"currentColor\">\n      <path d=\"M5.242 13.769L0.5 9.5 12 1l11.5 8.5-4.742 4.269C17.548 11.249 14.978 9.5 12 9.5c-2.977 0-5.548 1.748-6.758 4.269zM12 10a7 7 0 1 0 0 14 7 7 0 0 0 0-14z\"\/>\n    <\/svg>\n  <\/a>\n  \n<\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Men arrive at my clinic with a syphilis result and one of two stories. Either they have just been diagnosed and are frightened, or they were treated somewhere else, their blood test is still positive months later, and they have been told \u2014 or have concluded \u2014 that the treatment failed. The second group is much larger than it should be, and most of them were never actually treatment failures at all. This article is mainly about why.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A note on what this article is.<\/strong> It explains how syphilis is treated and followed up so that you understand what is being done and what to expect. It does not print drug doses or schedules: the course depends on the stage of the infection, on whether it has reached the nervous system, on pregnancy and on allergy, and getting that wrong is how inadequate treatment happens. This page was originally written from the CDC\u2019s 2015 recommendations, which have since been superseded by the CDC 2021 sexually transmitted infections treatment guidelines; the essentials described here have not changed.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Urology center Bangkok hospital Thailand\u00a0<a href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\" target=\"_blank\" rel=\"noreferrer noopener\">Booking online<\/a>\u00a0<a href=\"tel:02-310-3009\">02-310-3009<\/a>\u00a0<a href=\"mailto:bhquro@bdms.co.th\">bhquro@bdms.co.th<\/a><\/li>\n\n\n\n<li>Samitivej Sriracha hospital Chonburi&nbsp;<a href=\"tel:088-022-1445\">088-022-1445<\/a><\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" decoding=\"async\" width=\"800\" height=\"533\" data-attachment-id=\"4257\" data-permalink=\"https:\/\/drsoaraweeurology.com\/ko\/2021\/10\/08\/syphilis-correct-way-deal-with\/upset-patient\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Upset-patient.jpg?fit=1200%2C800&amp;ssl=1\" data-orig-size=\"1200,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;copyright&quot;:&quot;Freepik Company S.L. - www.freepik.com&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"Fail-to-treat Syphilis infection at local clinic is happened frequently.\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Fail-to-treat Syphilis infection at local clinic is happened frequently.&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Upset-patient.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Upset-patient.jpg?resize=800%2C533&#038;ssl=1\" alt=\"A worried man holding a laboratory report \u2014 a persistently positive syphilis blood test after treatment causes considerable distress\" class=\"wp-image-4257\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Upset-patient.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Upset-patient.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Upset-patient.jpg?resize=1024%2C683&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Upset-patient.jpg?resize=768%2C512&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Upset-patient.jpg?resize=18%2C12&amp;ssl=1 18w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">A blood test that stays positive after treatment is the commonest reason men believe their syphilis was not cured.<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">The Treatment Itself Is the Simple Part<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Syphilis remains fully sensitive to penicillin. It has never developed resistance to it, which is remarkable for an organism we have been treating since the 1940s. First-line treatment is <strong>an intramuscular injection of long-acting benzathine penicillin<\/strong>, and how many injections you need depends entirely on the stage: early infection needs less, late or long-standing infection needs a longer course. This is exactly why staging \u2014 how long you have had it, which is often unknown \u2014 is part of the assessment rather than a formality.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" decoding=\"async\" width=\"800\" height=\"533\" data-attachment-id=\"4255\" data-permalink=\"https:\/\/drsoaraweeurology.com\/ko\/2021\/10\/08\/syphilis-correct-way-deal-with\/young-doctor-is-holding-hypodermic-syringe-with-vaccine-vial-rubber-gloves-on-gray-background\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Pen-injection.jpg?fit=1200%2C800&amp;ssl=1\" data-orig-size=\"1200,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;13&quot;,&quot;camera&quot;:&quot;Canon EOS 5D Mark III&quot;,&quot;caption&quot;:&quot;Young doctor is  holding  hypodermic syringe with  vaccine vial  rubber gloves on gray background.&quot;,&quot;created_timestamp&quot;:&quot;1586013043&quot;,&quot;focal_length&quot;:&quot;200&quot;,&quot;iso&quot;:&quot;100&quot;,&quot;shutter_speed&quot;:&quot;0.01&quot;,&quot;title&quot;:&quot;Young doctor is  holding  hypodermic syringe with  vaccine vial  rubber gloves on gray background.&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"Benzathine Penicillin G intramuscular injection is considered as first line treatment.\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Benzathine Penicillin G intramuscular injection is considered as first line treatment.&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Pen-injection.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Pen-injection.jpg?resize=800%2C533&#038;ssl=1\" alt=\"Intramuscular injection being given \u2014 long-acting benzathine penicillin remains first-line treatment for syphilis\" class=\"wp-image-4255\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Pen-injection.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Pen-injection.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Pen-injection.jpg?resize=1024%2C683&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Pen-injection.jpg?resize=768%2C512&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/Pen-injection.jpg?resize=18%2C12&amp;ssl=1 18w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Benzathine penicillin by intramuscular injection; the number of injections depends on the stage.<\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Three situations change the answer completely, and they are the reason self-treatment or a borrowed prescription is dangerous here:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Penicillin allergy.<\/strong> An oral antibiotic can be substituted in some circumstances \u2014 but not in all of them, and the decision is not interchangeable with the injection.<\/li>\n\n\n\n<li><strong>Pregnancy.<\/strong> Penicillin is the only treatment that reliably protects the baby. A pregnant woman with penicillin allergy is <em>desensitised<\/em> to penicillin and then treated with it, rather than given an alternative. Untreated syphilis in pregnancy causes stillbirth and congenital syphilis, so this is not a corner to cut.<\/li>\n\n\n\n<li><strong>Involvement of the nervous system, eye or ear.<\/strong> This needs intravenous penicillin in hospital \u2014 the intramuscular injection does not reach those tissues adequately. And it does not only happen late: it can occur at any stage, including early infection.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Get Help Urgently for These<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Whether you are being treated or awaiting treatment, these need same-day assessment rather than a routine appointment \u2014 attend an emergency department or call <strong>1669<\/strong> in Thailand:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Any change in vision<\/strong> \u2014 blurring, floaters, a red painful eye, or loss of vision. Ocular syphilis can destroy sight and is treated as an emergency<\/li>\n\n\n\n<li><strong>New hearing loss, ringing in the ears or vertigo<\/strong><\/li>\n\n\n\n<li><strong>Severe headache, neck stiffness, confusion, or weakness or numbness in a limb<\/strong><\/li>\n\n\n\n<li><strong>In pregnancy:<\/strong> fever, contractions or reduced fetal movement after a treatment injection<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">The Reaction That Frightens People on the First Night<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Within a day of the first injection, many people develop fever, chills, headache, aching muscles and sometimes a flare of the rash. This is the <strong>Jarisch\u2013Herxheimer reaction<\/strong>. It is not a penicillin allergy and it is not the infection getting worse \u2014 it is the body\u2019s inflammatory response to large numbers of bacteria dying at once, and it usually settles within about a day with rest, fluids and simple fever medication.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Knowing this in advance matters, because a man who is not warned assumes he is allergic, stops, and leaves himself untreated. Two qualifications belong with it, though: <strong>in pregnancy the reaction can provoke contractions and fetal distress<\/strong> and needs monitoring, and any reaction that is severe, that includes breathing difficulty, facial or throat swelling, or that does not settle as expected, should be assessed rather than assumed to be Herxheimer.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" width=\"800\" height=\"533\" data-attachment-id=\"4256\" data-permalink=\"https:\/\/drsoaraweeurology.com\/ko\/2021\/10\/08\/syphilis-correct-way-deal-with\/bare-human-feet-sticking-out-from-the-bed\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/SI.jpg?fit=1200%2C800&amp;ssl=1\" data-orig-size=\"1200,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;2.8&quot;,&quot;credit&quot;:&quot;Anna Bizon&quot;,&quot;camera&quot;:&quot;NIKON D3X&quot;,&quot;caption&quot;:&quot;Bare human feet sticking out from the bed&quot;,&quot;created_timestamp&quot;:&quot;1424441944&quot;,&quot;copyright&quot;:&quot;Gpoint Studio&quot;,&quot;focal_length&quot;:&quot;36&quot;,&quot;iso&quot;:&quot;100&quot;,&quot;shutter_speed&quot;:&quot;0.01&quot;,&quot;title&quot;:&quot;Bare human feet sticking out from the bed&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"Avoid sexual activity is recommended during the treatment.\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Avoid sexual activity is recommended during the treatment.&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/SI.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/SI.jpg?resize=800%2C533&#038;ssl=1\" alt=\"A couple with distance between them \u2014 sexual contact is avoided until treatment is complete and lesions have healed\" class=\"wp-image-4256\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/SI.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/SI.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/SI.jpg?resize=1024%2C683&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/SI.jpg?resize=768%2C512&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/SI.jpg?resize=18%2C12&amp;ssl=1 18w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">No sexual contact, including oral sex, until treatment is complete and any sores have fully healed.<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">What You Have To Do Afterwards<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>No sexual contact, including oral sex<\/strong>, until treatment is complete, any sores have fully healed, and at least seven days have passed. Syphilis sores are highly infectious, and condoms do not cover every site where a sore can sit.<\/li>\n\n\n\n<li><strong>Partners must be told and assessed.<\/strong> Recent partners are usually treated presumptively \u2014 that is, treated on the basis of the exposure rather than waiting for their own test to turn positive, because a test taken too early can be negative in someone who is nonetheless infected.<\/li>\n\n\n\n<li><strong>Get tested for the other infections.<\/strong> Gonorrhoea and chlamydia travel with syphilis; a <a href=\"https:\/\/drsoaraweeurology.com\/2020\/05\/28\/stis-std-pcr-urine-test\/\">urine PCR panel<\/a> covers several at once. HIV testing, and pre- or post-exposure prophylaxis, are handled by the Infectious Diseases department at Bangkok Hospital Headquarters rather than in the urology clinic \u2014 and PEP is time-critical, needed within 72 hours of a high-risk exposure.<\/li>\n\n\n\n<li><strong>Keep the follow-up blood tests.<\/strong> They are the only way anyone can tell whether the treatment worked.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">A Correction: Your Blood Test May Never Turn Negative<\/h2>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" width=\"800\" height=\"533\" data-attachment-id=\"4254\" data-permalink=\"https:\/\/drsoaraweeurology.com\/ko\/2021\/10\/08\/syphilis-correct-way-deal-with\/closeup-of-blood-tube-test-2\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/VDRL-test.jpg?fit=1200%2C800&amp;ssl=1\" data-orig-size=\"1200,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;caption&quot;:&quot;Closeup of blood tube test&quot;,&quot;copyright&quot;:&quot;Rawpixel Ltd.&quot;,&quot;iso&quot;:&quot;500&quot;,&quot;title&quot;:&quot;Closeup of blood tube test&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"VDRL blood test is the tool we use for tracking treatment success.\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;VDRL blood test is the tool we use for tracking treatment success.&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/VDRL-test.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/VDRL-test.jpg?resize=800%2C533&#038;ssl=1\" alt=\"Blood sample tubes in a laboratory \u2014 serial nontreponemal titres such as VDRL or RPR are used to confirm syphilis cure\" class=\"wp-image-4254\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/VDRL-test.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/VDRL-test.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/VDRL-test.jpg?resize=1024%2C683&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/VDRL-test.jpg?resize=768%2C512&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/10\/VDRL-test.jpg?resize=18%2C12&amp;ssl=1 18w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Cure is judged by the fall in the titre over time, not by the test becoming negative.<\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">An earlier version of this article stated that the VDRL typically becomes negative six to twelve months after successful treatment. <strong>That is not reliably true, and it has caused a great deal of unnecessary alarm \u2014 so it is corrected here.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">There are two different kinds of syphilis blood test, and confusing them is the root of the problem. I have written about the distinction in detail in <a href=\"https:\/\/drsoaraweeurology.com\/2020\/11\/27\/syphilis-confusion-tests\/\">why there are two kinds of syphilis test<\/a>, but in short:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>The treponemal test<\/strong> (TPHA, TPPA and similar) usually stays positive <strong>for the rest of your life<\/strong>, cured or not. It is not a measure of cure and repeating it tells you nothing about whether treatment worked.<\/li>\n\n\n\n<li><strong>The nontreponemal test<\/strong> (VDRL or RPR) is reported as a titre, and it is the one that is followed. <strong>Cure is judged by a fourfold fall in that titre<\/strong> over an expected period \u2014 for example from 1:32 to 1:8 \u2014 not by the test turning negative.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">A proportion of properly treated people never become negative at all: the titre falls, then settles at a low level and stays there indefinitely. This is called the <strong>serofast state<\/strong>. It is well recognised, it does not mean the infection persists, and it does not mean more penicillin is needed. It is, in my experience, the single commonest reason a man is told at another clinic that his treatment failed \u2014 and then retreated unnecessarily, sometimes more than once.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">What genuinely does warrant re-evaluation is the opposite pattern: a titre that <strong>fails to fall<\/strong> as expected, or that <strong>rises fourfold<\/strong>. That means either true treatment failure or, far more often, reinfection from an untreated partner \u2014 and the answer to the second is not simply another injection for you.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Frequently Asked Questions<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">How is syphilis treated?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">With an intramuscular injection of long-acting benzathine penicillin. The number of injections depends on the stage of infection, which is why staging is part of the assessment. Syphilis has never become resistant to penicillin. An oral alternative can be used in some penicillin-allergic patients, but not in pregnancy \u2014 where the woman is desensitised and treated with penicillin instead \u2014 and not where the nervous system, eye or ear is involved, which requires intravenous penicillin in hospital.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">My syphilis blood test is still positive after treatment. Did it fail?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Usually not. The treponemal test (TPHA, TPPA) stays positive for life in most people and is not a measure of cure. The nontreponemal test (VDRL, RPR) is the one followed, and cure is judged by a fourfold fall in the titre, not by it becoming negative. Some fully treated people settle at a low positive titre permanently \u2014 the serofast state \u2014 which does not mean persisting infection and does not need more penicillin. Retreatment on that basis is a common and avoidable mistake.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">When does syphilis treatment genuinely need repeating?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">When the nontreponemal titre fails to fall as expected, or rises fourfold. That indicates either true treatment failure or, more commonly, reinfection from an untreated partner. Both need re-evaluation rather than an automatic repeat injection, and reinfection is not solved by treating you again while the source goes untreated.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">I felt feverish and unwell the night after my injection. Am I allergic?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Most likely not. Fever, chills, headache, muscle aches and a flare of rash within a day of the first injection is the Jarisch\u2013Herxheimer reaction \u2014 an inflammatory response to large numbers of bacteria dying at once. It is not an allergy and usually settles within about a day with rest, fluids and simple fever medication. But breathing difficulty, facial or throat swelling, or a reaction that is severe or does not settle should be assessed rather than assumed. In pregnancy the reaction can provoke contractions and fetal distress and needs monitoring.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">When is syphilis an emergency?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Any change in vision, a red painful eye, new hearing loss, ringing in the ears or vertigo, or severe headache with neck stiffness, confusion or limb weakness. Syphilis can involve the eye, ear and nervous system at any stage, including early infection, and those require intravenous treatment in hospital rather than the usual injection. Attend an emergency department or call 1669 in Thailand.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Do my partners need treatment?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Yes. Recent partners are usually treated presumptively, on the basis of the exposure rather than waiting for their own test to turn positive, because a test taken soon after exposure can be negative in someone who is infected. Avoid sexual contact, including oral sex, until treatment is complete, any sores have healed, and at least seven days have passed.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Book an Appointment<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Dr. Soarawee Weerasopone provides confidential testing and treatment for sexually transmitted infections at <a href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\" target=\"_blank\" rel=\"noreferrer noopener\">Bangkok Hospital Headquarters<\/a> and at Samitivej Sriracha Hospital, Chonburi \u2014 Urology department <a href=\"tel:0880221445\">088-022-1445<\/a>. HIV testing and PrEP or PEP are handled by the Infectious Diseases department rather than the urology clinic. Questions about cost are answered by the hospital rather than by Dr. Soarawee \u2014 for Bangkok Hospital, by email to <a href=\"mailto:bhquro@bdms.co.th\">bhquro@bdms.co.th<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Bangkok Hospital Telemedicine is available for patients who cannot attend in person, including international patients \u2014 arrange it in advance by email to the Urology department at <a href=\"mailto:bhquro@bdms.co.th\">bhquro@bdms.co.th<\/a>. Blood testing and treatment injections require an in-person visit. Samitivej Sriracha is in-person only.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Disclaimer:<\/strong> This article is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is educational only, is not medical advice, and does not create a doctor\u2013patient relationship. It gives no drug doses or schedules: the correct course depends on the stage of infection, on pregnancy, on allergy and on whether the nervous system, eye or ear is involved, and syphilis must not be self-treated. Local guidance may differ from the international guidance described here. No diagnosis, prescription or individual medical advice is given through personal messaging channels or social media, and Dr. Soarawee operates no public social media account \u2014 any account offering private consultation in his name is fraudulent. For any change in vision, new hearing loss, or severe headache with neck stiffness or confusion, go to an emergency department or call 1669 in Thailand.<\/p>\n\n\n\n<script type=\"application\/ld+json\">\n{\n  \"@context\": \"https:\/\/schema.org\",\n  \"@graph\": [\n    {\n      \"@type\": \"MedicalWebPage\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/10\/08\/syphilis-correct-way-deal-with\/#webpage\",\n      \"url\": \"https:\/\/drsoaraweeurology.com\/2021\/10\/08\/syphilis-correct-way-deal-with\/\",\n      \"name\": \"Syphilis Treatment: How It Is Cured, and How You Know It Worked\",\n      \"description\": \"How syphilis is treated with benzathine penicillin, how cure is confirmed by a fourfold fall in the nontreponemal titre rather than by the test becoming negative, what the serofast state is, and the ocular, otological and neurological presentations that require urgent intravenous treatment.\",\n      \"inLanguage\": \"en\",\n      \"datePublished\": \"2021-10-08\",\n      \"dateModified\": \"2026-08-22\",\n      \"lastReviewed\": \"2026-08-22\",\n      \"specialty\": \"https:\/\/schema.org\/Urologic\",\n      \"isPartOf\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#website\" },\n      \"author\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"reviewedBy\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"publisher\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"medicalAudience\": { \"@type\": \"MedicalAudience\", \"audienceType\": \"Patient\" },\n      \"about\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/10\/08\/syphilis-correct-way-deal-with\/#syphilis\" },\n      \"disambiguatingDescription\": \"Corrected August 2026. An earlier version stated that the VDRL typically becomes negative six to twelve months after successful treatment; that is not reliably true and has been replaced with the fourfold-titre-fall criterion and an explanation of the serofast state. Drug doses and schedules have been removed because the correct course depends on stage, pregnancy, allergy and neurological, ocular or otological involvement. Originally written from the CDC 2015 recommendations, since superseded by the CDC 2021 sexually transmitted infections treatment guidelines. HIV testing and PrEP or PEP are not provided in the urology clinic at Bangkok Hospital Headquarters and are handled by the Infectious Diseases department.\"\n    },\n    {\n      \"@type\": \"MedicalCondition\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/10\/08\/syphilis-correct-way-deal-with\/#syphilis\",\n      \"name\": \"Syphilis\",\n      \"alternateName\": \"Treponema pallidum infection\",\n      \"description\": \"A curable bacterial sexually transmitted infection that remains fully sensitive to penicillin. Treatment is staged, and cure is assessed serologically by the trend in the nontreponemal titre rather than by seroreversion.\",\n      \"possibleTreatment\": {\n        \"@type\": \"MedicalTherapy\",\n        \"name\": \"Intramuscular benzathine penicillin, with intravenous penicillin for neurological, ocular or otological involvement\",\n        \"description\": \"Number of injections depends on the stage of infection. Oral alternatives may be used in some penicillin-allergic patients but not in pregnancy, where desensitisation and penicillin treatment are required, and not where the nervous system, eye or ear is involved. Doses and schedules are determined clinically and are not suitable for self-treatment.\"\n      },\n      \"typicalTest\": {\n        \"@type\": \"MedicalTest\",\n        \"name\": \"Treponemal and nontreponemal serology\",\n        \"description\": \"Treponemal tests such as TPHA or TPPA usually remain positive for life and do not indicate cure. Nontreponemal tests such as VDRL or RPR are titred and followed serially; a fourfold fall indicates response. A persistent low-level positive titre after adequate treatment is the serofast state and does not indicate persisting infection or require retreatment. Failure of the titre to fall, or a fourfold rise, indicates treatment failure or reinfection and requires re-evaluation.\"\n      },\n      \"possibleComplication\": \"Ocular syphilis threatening sight; otosyphilis with hearing loss, tinnitus or vertigo; neurosyphilis, which may occur at any stage including early infection and requires intravenous treatment; congenital syphilis and stillbirth in untreated pregnancy; and Jarisch-Herxheimer reaction after the first dose, which can provoke contractions and fetal distress in pregnancy.\"\n    },\n    {\n      \"@type\": \"FAQPage\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/10\/08\/syphilis-correct-way-deal-with\/#faq\",\n      \"isPartOf\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/10\/08\/syphilis-correct-way-deal-with\/#webpage\" },\n      \"mainEntity\": [\n        {\n          \"@type\": \"Question\",\n          \"name\": \"How is syphilis treated?\",\n          \"acceptedAnswer\": {\n            \"@type\": \"Answer\",\n            \"text\": \"With an intramuscular injection of long-acting benzathine penicillin. The number of injections depends on the stage of infection. Syphilis has never become resistant to penicillin. An oral alternative may be used in some penicillin-allergic patients, but not in pregnancy, where the woman is desensitised and treated with penicillin instead, and not where the nervous system, eye or ear is involved, which requires intravenous penicillin in hospital.\"\n          }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"My syphilis blood test is still positive after treatment. Did the treatment fail?\",\n          \"acceptedAnswer\": {\n            \"@type\": \"Answer\",\n            \"text\": \"Usually not. The treponemal test such as TPHA or TPPA stays positive for life in most people and is not a measure of cure. The nontreponemal test such as VDRL or RPR is the one followed, and cure is judged by a fourfold fall in the titre rather than by it becoming negative. Some fully treated people settle at a low positive titre permanently, known as the serofast state, which does not indicate persisting infection and does not require further penicillin.\"\n          }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"When does syphilis treatment genuinely need repeating?\",\n          \"acceptedAnswer\": {\n            \"@type\": \"Answer\",\n            \"text\": \"When the nontreponemal titre fails to fall as expected or rises fourfold. That indicates either true treatment failure or, more commonly, reinfection from an untreated partner. Both require re-evaluation rather than an automatic repeat injection.\"\n          }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Is fever after the first syphilis injection an allergic reaction?\",\n          \"acceptedAnswer\": {\n            \"@type\": \"Answer\",\n            \"text\": \"Usually not. Fever, chills, headache, muscle aches and a flare of rash within a day of the first injection is the Jarisch-Herxheimer reaction, an inflammatory response to large numbers of bacteria dying at once. It is not an allergy and usually settles within about a day. Breathing difficulty, facial or throat swelling, or a severe or persistent reaction should be assessed. In pregnancy the reaction can provoke contractions and fetal distress and requires monitoring.\"\n          }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"When is syphilis a medical emergency?\",\n          \"acceptedAnswer\": {\n            \"@type\": \"Answer\",\n            \"text\": \"Any change in vision, a red painful eye, new hearing loss, tinnitus or vertigo, or severe headache with neck stiffness, confusion or limb weakness. Syphilis can involve the eye, ear and nervous system at any stage including early infection, and these require intravenous treatment in hospital rather than the usual intramuscular injection.\"\n          }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Do sexual partners need treatment for syphilis?\",\n          \"acceptedAnswer\": {\n            \"@type\": \"Answer\",\n            \"text\": \"Yes. Recent partners are usually treated presumptively on the basis of exposure rather than waiting for their own test to turn positive, because a test taken soon after exposure can be negative in an infected person. Sexual contact including oral sex should be avoided until treatment is complete, any sores have healed and at least seven days have passed.\"\n          }\n        }\n      ]\n    }\n  ]\n}\n<\/script>\n","protected":false},"excerpt":{"rendered":"<p>70\ub144 \ub3d9\uc548 \ubcc0\ud558\uc9c0 \uc54a\uc740 \uc8fc\uc0ac\ub97c \ud1b5\ud574 \ub9e4\ub3c5\uc744 \uce58\ub8cc\ud560 \uc218 \uc788\uc2b5\ub2c8\ub2e4. \uac70\uc758 \ubaa8\ub4e0 \uc0ac\ub78c\uc5d0\uac8c \ud63c\ub780\uc744 \uc8fc\ub294 \uac83\uc740 \uadf8 \ud6c4 \ud608\uc561 \uac80\uc0ac \uacb0\uacfc\uac00 \uc5b4\ub5bb\uac8c \ub418\ub294\uc9c0\uc785\ub2c8\ub2e4. \uc18c\ub77c\uc704 \uc704\uc5b4\uc0ac\ud3f0 \ubc15\uc0ac\ub294 \uc65c \uae0d\uc815\uc801\uc778 \uac80\uc0ac \uacb0\uacfc\uac00 \uce58\ub8cc \uc2e4\ud328\ub97c \uc758\ubbf8\ud558\uc9c0 \uc54a\ub294\uc9c0, \uadf8\ub9ac\uace0 \uac10\uc5fc\uc774 \uc2e0\uacbd\uc774\ub098 \ub208\uc5d0 \ub3c4\ub2ec\ud588\uc74c\uc744 \uc758\ubbf8\ud558\ub294 \uc99d\uc0c1\ub4e4\uc740 \ubb34\uc5c7\uc778\uc9c0 \uc124\uba85\ud569\ub2c8\ub2e4.<\/p>","protected":false},"author":185281453,"featured_media":10102,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"advanced_seo_description":"How syphilis is treated and how cure is confirmed \u2014 why the blood test can stay positive for life without meaning failure, what the serofast state is, and the neurological, eye and ear symptoms that need urgent care.","jetpack_seo_html_title":"Syphilis Treatment and How Cure Is Confirmed | Dr. Pom","jetpack_seo_noindex":false,"jetpack_seo_schema_type":"","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_wpcom_ai_launchpad_first_post":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"{title}\n\n{excerpt}\n\n{url}","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"_wpas_customize_per_network":false,"jetpack_post_was_ever_published":false},"categories":[1365],"tags":[1510,1445,1446],"class_list":["post-4244","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-sexual-transmitted-diseases","tag-std","tag-syphilis","tag-syphilis-test"],"jetpack_publicize_connections":[],"jetpack_likes_enabled":false,"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/pgZdrK-16s","jetpack_featured_media_url":"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/Syphilis-Treatment.jpg?fit=1200%2C630&ssl=1","_links":{"self":[{"href":"https:\/\/drsoaraweeurology.com\/ko\/wp-json\/wp\/v2\/posts\/4244","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drsoaraweeurology.com\/ko\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drsoaraweeurology.com\/ko\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/ko\/wp-json\/wp\/v2\/users\/185281453"}],"replies":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/ko\/wp-json\/wp\/v2\/comments?post=4244"}],"version-history":[{"count":20,"href":"https:\/\/drsoaraweeurology.com\/ko\/wp-json\/wp\/v2\/posts\/4244\/revisions"}],"predecessor-version":[{"id":11609,"href":"https:\/\/drsoaraweeurology.com\/ko\/wp-json\/wp\/v2\/posts\/4244\/revisions\/11609"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/ko\/wp-json\/wp\/v2\/media\/10102"}],"wp:attachment":[{"href":"https:\/\/drsoaraweeurology.com\/ko\/wp-json\/wp\/v2\/media?parent=4244"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/ko\/wp-json\/wp\/v2\/categories?post=4244"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/ko\/wp-json\/wp\/v2\/tags?post=4244"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}