From the Guidelines
The recommended treatment for a patient with a positive skin biopsy for stage 2 syphilis, despite negative blood and urine tests, is intramuscular benzathine penicillin G 2.4 million units administered once weekly for three consecutive weeks (total 7.2 million units). This treatment approach is based on the guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents, which state that penicillin remains the treatment of choice for syphilis regardless of HIV status 1. For patients with penicillin allergy, alternatives include doxycycline 100 mg orally twice daily for 28 days or tetracycline 500 mg orally four times daily for 28 days. Some key points to consider in the treatment of syphilis include:
- Patients should be monitored clinically and serologically at 6,12, and 24 months after treatment to ensure adequate response.
- False-negative serological tests can occur in secondary syphilis due to the prozone phenomenon (antibody excess) or immunological factors, but this doesn't change the treatment approach.
- The skin biopsy provides definitive diagnosis in this case, and treatment should proceed based on this finding.
- Sexual partners from the past 90 days should also be evaluated and treated presumptively, and the patient should abstain from sexual contact until treatment is completed and lesions have resolved. It's also important to note that treatment failures can occur with any regimen, and assessing response to treatment often is difficult, and definitive criteria for cure or failure have not been established 1. However, the use of alternative tests such as biopsy of a lesion, darkfield examination, or direct fluorescent antibody staining of lesion material may be useful when clinical findings suggest that syphilis is present, but serologic tests are nonreactive or unclear 1.
From the Research
Treatment for Stage 2 Syphilis
The patient has a positive skin biopsy for stage 2 syphilis, despite negative blood and urine tests. The treatment for stage 2 syphilis typically involves antibiotics.
- The primary recommended treatment is intramuscular benzathine penicillin G (BPG) 2.
- However, in cases where BPG is not available, doxycycline can be used as an alternative treatment 3, 2.
- Azithromycin has also been studied as a potential treatment for syphilis, with promising results 4.
Treatment Options
The following treatment options are available:
- Benzathine penicillin G (BPG): 2.4 million units administered intramuscularly as a single dose 4, 2.
- Doxycycline: 100 mg administered orally twice daily for 14 days for early syphilis, and 28 days for late latent or undetermined syphilis 3.
- Azithromycin: 2.0 g administered orally as a single dose, or two 2.0 g doses given 1 week apart 4.
Considerations
It is essential to note that the treatment should be guided by a healthcare professional, taking into account the patient's medical history, allergy status, and the availability of medications.