What is the treatment for tertiary syphilis (late-stage syphilis) with an aortic aneurysm?

From the Guidelines

Treatment of Tertiary Syphilis with Aortic Aneurysm

The treatment for tertiary syphilis with an aortic aneurysm involves a combination of antibiotic therapy and surgical management of the aneurysm 1.

Antibiotic Therapy

The primary treatment for tertiary syphilis is benzathine penicillin G administered at a dose of 2.4 million units intramuscularly once weekly for 3 weeks, as recommended by the Centers for Disease Control and Prevention (CDC) 1. This regimen is aimed at eradicating the syphilis infection.

Surgical Management

For patients with aneurysms due to syphilis, particularly those involving the aorta, surgical intervention may be necessary to repair or replace the affected portion of the aorta 1. The decision for surgical intervention depends on the size and location of the aneurysm, as well as the patient's overall health status.

Multidisciplinary Approach

In addition to antibiotic therapy and surgical management, patients with tertiary syphilis and aneurysm should be closely monitored for potential complications, including:

• Cardiac involvement
• Neurological involvement It's crucial to note that the treatment of tertiary syphilis and its complications, such as aneurysms, requires a multidisciplinary approach involving:
• Infectious disease specialists
• Cardiologists
• Cardiothoracic surgeons to ensure optimal patient outcomes 1.

From the FDA Drug Label

Late (tertiary and neurosyphilis)—2,400,000 units at 7-day intervals for three doses. The treatment for tertiary syphilis (late-stage syphilis) is 2,400,000 units of penicillin G administered at 7-day intervals for three doses.

• Key points:
  • Dose: 2,400,000 units
  • Frequency: every 7 days
  • Duration: three doses 2

From the Research

Treatment for Tertiary Syphilis with Aortic Aneurysm

The treatment for tertiary syphilis with an aortic aneurysm typically involves a combination of medical and surgical interventions.

• Medical treatment with antibiotics, such as IV penicillin, is the first line of treatment for syphilitic aortic aneurysm 3.
• Surgical repair of the aortic aneurysm is often necessary to prevent life-threatening complications, such as aortic rupture or dissection 4, 5, 3, 6.
• The surgical approach may vary depending on the location and extent of the aneurysm, as well as the presence of other cardiovascular complications, such as aortic regurgitation or coronary ostial stenosis 4, 5, 7.
• In some cases, a staged surgical repair may be necessary to address extensive cardiovascular damage caused by syphilis 7.
• The use of a single upper hemisternotomy approach for total arch replacement has been reported to have advantages over traditional full sternotomy, including faster postoperative recovery and less incisional pain 5.

Surgical Indications

Surgical indications for syphilitic aortic aneurysm include:

• Symptom relief
• Prevention of aortic rupture or sudden death
• Aortic valve insufficiency
• Aortic aneurysm
• Syphilis 5

Importance of Early Diagnosis and Treatment

Early diagnosis and treatment of syphilitic aortic aneurysm are crucial to prevent life-threatening complications and improve patient outcomes 4, 3, 6. A high index of suspicion is required for the early recognition of syphilitic aortic aneurysm, especially in patients with a history of untreated syphilis or those presenting with deceptive clinical symptoms 3.