Recommendations for the Treatment of Syphilisa
| Stage of Syphilis | Patients without Penicillin Allergy | Patients with Confirmed Penicillin Allergyb |
|---|---|---|
| Primary, secondary, or early latent | CSF normal or not examined:Penicillin G benzathine (single dose of 2.4 mU IM) | CSF normal or not examined:Tetracycline HCl (500 mg PO qid) or doxycycline (100 mg PO bid) for 2 weeks |
| CSF abnormal: Treat as neurosyphilis | CSF abnormal: Treat as neurosyphilis | |
| Late latent (or latent of uncertain duration), cardiovascular, or benign tertiary | CSF normal or not examined: Penicillin G benzathine (2.4 mU IM weekly for 3 weeks) CSF abnormal: Treat as neurosyphilis | CSF normal and pt not infected with HIV: Tetracycline HCl (500 mg PO qid) or doxycycline (100 mg PO bid) for 4 weeks CSF normal and pt infected with HIV: Desensitization and treatment with penicillin if compliance cannot be ensured CSF abnormal: Treat as neurosyphilis |
| Neurosyphilis (asymptomatic or symptomatic) | Aqueous crystalline penicillin G (18-24 mU/d IV, given as 3-4 mU q4h or continuous infusion) for 10-14 days or Aqueous procaine penicillin G (2.4 mU/d IM) plus oral probenecid (500 mg qid), both for 10-14 days | Desensitization and treatment with penicillinc |
| Syphilis in pregnancy | According to stage | Desensitization and treatment with penicillin |
aSee text for indications for CSF examination.
bBecause of the documented presence of macrolide resistance in many T. pallidum strains in North America, Europe, and China, azithromycin or other macrolides should be used with caution only when treatment with penicillin or doxycycline is not feasible. Azithromycin should not be used for men who have sex with men or for pregnant women.
cLimited data suggest that ceftriaxone (2 g/d either IM or IV for 10-14 days) can be used; however, cross-reactivity between penicillin and ceftriaxone is possible.
Abbreviations: mU, million units.
Source: Adapted from the 2010 Sexually Transmitted Diseases Treatment Guidelines from the Centers for Disease Control and Prevention.