Answer 5 Continue present treatment. The Jarisch-Herxheimer reaction may develop within several hours after beginning antibiotic treatment. This reaction manifests with fever, chills, and rigors and can occur as early as 2 hours after exposure to an antibiotic. It is often mistaken for an allergic reaction. The Jarisch-Herxheimer reaction is a self-limited febrile inflammatory response. It can occur in the treatment of any stage of syphilis but is more common during the secondary stage. Treatment of the Jarisch-Herxheimer reaction is largely supportive, such as administering an antipyretic drug (acetaminophen). Antibiotic treatment should be continued. Desensitization can be considered in the treatment of neurosyphilis for penicillin-allergic patients. Blood cultures are not helpful in the evaluation of syphilis, as the organism cannot be cultured. Click here to return to the questions
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