From the Guidelines
The treatment for syphilis is primarily penicillin G, administered as an intramuscular injection, with the most recent and highest quality study 1 supporting its use as the first-line treatment. The recommended regimen for primary, secondary, or early latent syphilis (less than one year duration) is a single dose of benzathine penicillin G 2.4 million units. For late latent syphilis (more than one year duration) or syphilis of unknown duration, the recommended regimen is benzathine penicillin G 2.4 million units intramuscularly once weekly for three consecutive weeks. Neurosyphilis requires a more intensive approach with aqueous crystalline penicillin G 3-4 million units intravenously every 4 hours for 10-14 days. Some key points to consider in the treatment of syphilis include:
- The use of doxycycline 100 mg orally twice daily for 14 days (primary, secondary, early latent) or 28 days (late latent) as an alternative for patients allergic to penicillin, although it is considered less effective 1.
- The potential use of ceftriaxone as an alternative treatment for early syphilis, with a regimen of 1 g/d of intravenous ceftriaxone for 10 days compared with 2 intramuscular doses of 2.4-million units (MU) BPG 1.
- The importance of follow-up blood tests to ensure the infection is resolving, as well as notifying, testing, and treating sexual partners to prevent reinfection 1. It's worth noting that the most recent study 1 provides the most up-to-date guidance on the treatment of syphilis, and its recommendations should be prioritized in clinical practice.
From the FDA Drug Label
All cases of penicillin treated syphilis should receive adequate follow-up including clinical and serological examinations. The recommended follow-up varies with the stage of syphilis being treated. See CDC recommendations. Patients being treated for gonococcal infection should have a serologic test for syphilis before receiving penicillin.
The treatment for syphilis is penicillin G.
- Penicillin G is administered via intramuscular (IM) injection.
- It is essential to follow the CDC recommendations for the treatment and follow-up of syphilis cases.
- Patients should be monitored closely for clinical and laboratory evidence of toxic or adverse effects 2.
From the Research
Treatment Options for Syphilis
The treatment for syphilis typically involves the use of antibiotics, with the primary recommendation being penicillin for non-penicillin-allergic patients 3. However, alternative treatments have been explored due to concerns about penicillin resistance and the need for more convenient treatment options.
Penicillin-Based Treatments
- Benzathine penicillin G is the standard treatment for early syphilis, administered as an intramuscular injection 3, 4, 5.
- A single subcutaneous infusion of long-acting penicillin may be a feasible alternative for treating late-latent syphilis, offering reduced pain and fewer clinic visits 5.
Alternative Antibiotic Treatments
- Azithromycin has shown promise as an alternative treatment for syphilis, with studies indicating high response rates when administered as a single 2.0-g dose or as two 2.0-g doses given 1 week apart 3.
- Ceftriaxone and doxycycline have been found to be effective alternatives to penicillin in treating early syphilis, particularly in HIV-infected patients 4, 6.
- Doxycycline appears to be an effective agent for treating early syphilis, with no serological failures reported in one study 6.
Considerations for HIV-Positive Individuals
- The treatment of syphilis in HIV-positive individuals remains a topic of debate, with some studies suggesting that enhanced treatment may be necessary due to the potential for slower serological response or higher rates of asymptomatic neurosyphilis 7.
- The use of macrolides, cephalosporins, and doxycycline as alternative treatments for syphilis in HIV-positive individuals has been proposed, although macrolide resistance is a growing concern 7.