Effectiveness monitoring
In some cases, the effectiveness of the treatment should be monitored. On this page, you will find the control tests to be performed according to the infections treated.
Test of cure should be performed in the following situations:
- suspicion of treatment failure
- treatment with other drugs than recommended
- pregnant woman
Optional test of cure can be performed
- to ensure eradication of infection
- to identify emerging resistance
Scheme of the test of cure
If persistence of symptoms: sample all relevant anatomical sites 3-7 days after the end of treatment for gonococcal culture with antibiotic susceptibility testing
- If culture is negative: supplement with NAAT 14 days after completion of treatment.
- If NAAT is positive: refer to secondary care.
If asymptomatic: perform a NAAT four weeks after treatment completion.
- If NAAT is positive: perform a culture with antibiotic susceptibility testing of all the relevant anatomic sites before referral to secondary care and further treatment.
Test of cure should be performed in the following situations:
- suspicion of treatment failure
- pregnant woman
- treatment with other drugs than recommended
Scheme of the test of cure:
- NAAT four weeks after treatment completion
- If positive, refer to secondary care for further treatment
Always perform a test of cure
In case of a positive serology:
A. Clinical and serological (non-trep RPR) follow-up
- for early syphilis at 3 and 6 months
- for late syphilis at 3, 6 and 12 months
B. Referral is indicated:
- in case of recurrence of signs or symptoms
- when RPR titres do not decrease 4-fold within 6 months of day 1 of treatment for early syphilis (primary, secondary and early latent <1 year)
- when RPR titres do not decrease 4-fold within 12 months of day 1 of treatment for late syphilis (> 1 year)
In case of negative results (serum or PCR) in a patient with a suspected infection:
A. Symptomatic patient with ulcer(s) treated for syphilis:
- repeat serologic tests 6 weeks after ulcer appearance to exclude syphilis diagnosis
- potentially, perform serologic tests 2 weeks after ulcer appearance to exclude or confirm syphilis diagnosis
B. Asymptomatic patient after an isolated episode of high risk exposure to syphilis:
- repeat serologic test after 6 weeks (in all cases)
- and (optionally) 12 weeks after treatment according to laboratory procedures.
!! IF PREGNANT WOMAN: refer for treatment, control and follow-up
Refer for control and follow-up
Hepatitis A and/or B: in case of a negative test, perform a vaccination
Acute infection: refer to secondary care if abnormal liver tests
Chronic hepatitis B and C infections: always refer to secondary care, even if liver tests are normal.
If pregnant woman: refer for control and follow-up