Recommendations for the Treatment of Syphilisa

STAGE OF SYPHILIS	PTS WITHOUT PENICILLIN ALLERGY	PTS WITH CONFIRMED PENICILLIN ALLERGY
Recommendations for the Treatment of Syphilis ^a
Primary, secondary, or early latent	CSF normal or not examined:Penicillin G benzathine (single dose of 2.4 mU IM) CSF abnormal: Treat as neurosyphilis.	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.
Late latent (or latent of unknown 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: Desensitize and treat with penicillin if compliance cannot be assured. 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	Desensitize and treat with penicillin.
Syphilis in pregnancy	According to stage	Desensitize and treat with penicillin.

^a See text for indications for CSF examination.

Abbreviations: CSF, cerebrospinal fluid; mU, million units.

Source: Adapted from the 2015 Sexually Transmitted Diseases Treatment Guidelines from the Centers for Disease Control and Prevention.