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NACCHO and ASHM

Ongoing Monitoring After Treatment

Last Updated: June 2026

As per the Australian STI Management Guidelines follow-up post syphilis treatment should include:

Follow-up instructions AT the treatment appointment:

  • Advise no sexual contact for 7 days after treatment is commenced, or until the course is completed and symptoms resolved, whichever is later.
  • Advise no sex with partners from the last 3 months (primary syphilis), 6 months (secondary syphilis) or 12 months (early latent) until the partners have been tested and treated if necessary.
  • Notify the state or territory health department according to local procedures. Where a syphilis register exists in your State, Territory or region, ensure you promptly report the required details. Where there are any concerns or ambiguity, contact your local public health service for additional support.

Follow-up instructions POST the treatment appointment:

  • Confirm patient adherence with treatment.
  • Confirm contact tracing procedures have been undertaken or offer more contact tracing support.
  • Repeat serology – RPR only (at 3, 6 and 12 months) to assess response to treatment. A 4-fold drop (e.g. 1:8 to 1:2) indicates adequate response to treatment. Seek specialist advice if RPR is rising or a 4-fold drop is not achieved by 12 months. Note that follow-up requirements will vary in certain situations e.g. pregnancy.
  • Educate about condom use, contraception, HIV PrEP/PEP, safe injecting practices, consent, CST and vaccinations as indicated. Consider, providing patient with a fact sheet on syphilis or STIs.

Once reactive, the syphilis antibody PoCT test will remain positive for life, but a previous infection does NOT protect against re-infection of syphilis. Syphilis serology should continue to be tested as per clinical and jurisdictional guidance.

Test of cure

Repeat serology – RPR only (at 3,6 and 12 months) to assess response to treatment.

A 4-fold drop (e.g. 1:8 to 1:2) indicates adequate response to treatment. Seek specialist advice if RPR is rising or a 4-fold drop is not achieved by 12 months.