What is the treatment for Syphilis?

From the Guidelines

Syphilis is treated with antibiotics, primarily penicillin, with the most effective regimen being a single intramuscular injection of Benzathine penicillin G 2.4 million units for primary, secondary, or early latent syphilis. The treatment of syphilis is well-established, with penicillin remaining the treatment of choice for all stages of the disease, as supported by more than 40 years of clinical experience and recent clinical trials 1.

Key Considerations

• For primary, secondary, or early latent syphilis (less than one year duration), a single intramuscular injection of Benzathine penicillin G 2.4 million units is the recommended treatment.
• 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.
• For neurosyphilis or ocular syphilis, aqueous crystalline penicillin G 3-4 million units intravenously every 4 hours for 10-14 days is recommended.
• Patients with HIV infection who have early syphilis should be managed according to these standard treatment recommendations, but they may be at increased risk for neurologic complications and may have higher rates of treatment failure 1.

Alternative Treatments

• For patients allergic to penicillin, doxycycline 100 mg orally twice daily for 14 days (early syphilis) or 28 days (late syphilis) can be used, though it's less effective.

Follow-up

• Patients should abstain from sexual contact until treatment is complete and follow-up testing confirms cure.
• Follow-up blood tests are essential to ensure the infection has been successfully treated, typically at 3,6, and 12 months after treatment. The efficacy of penicillin for the treatment of syphilis was well established through clinical experience before the value of randomized controlled clinical trials was recognized, and nearly all the recommendations for the treatment of syphilis are based on expert opinion reinforced by case series, open clinical trials, and 50 years of clinical experience 1.

From the FDA Drug Label

Syphilis–early: Patients who are allergic to penicillin should be treated with doxycycline 100 mg, by mouth, twice a day for 2 weeks Syphilis of more than one year’s duration: Patients who are allergic to penicillin should be treated with doxycycline 100 mg, by mouth, twice a day for 4 weeks.

The treatment for Syphilis is doxycycline 100 mg, by mouth, twice a day for:

• 2 weeks for early syphilis in patients allergic to penicillin
• 4 weeks for syphilis of more than one year’s duration in patients allergic to penicillin 2

From the Research

Treatment Options for Syphilis

The treatment for syphilis typically involves the use of antibiotics, with penicillin being the primary recommended medication [(3,4)]. The specific treatment regimen may vary depending on the stage of the disease and the patient's overall health.

Penicillin-Based Treatments

• Benzathine penicillin G is the most commonly used penicillin-based treatment for syphilis, administered via intramuscular injection [(3,4,5)].
• A single dose of 2.4 million units of benzathine penicillin G is typically recommended for early syphilis [(3,5)].
• For late-latent syphilis, a single subcutaneous infusion of long-acting penicillin may be a viable treatment option 6.

Alternative Treatments

• Azithromycin has shown promise as an alternative treatment for syphilis, with studies demonstrating its effectiveness in treating early syphilis 3.
• Doxycycline is another alternative treatment option, with studies suggesting its efficacy in treating early syphilis 7.
• Ceftriaxone may also be considered as an alternative treatment, although its place in syphilis treatment is still being established 4.

Treatment Considerations for HIV-Infected Patients

• Patients coinfected with syphilis and HIV may require closer monitoring and follow-up due to potential differences in treatment response [(4,5)].
• A single dose of benzathine penicillin G is still recommended for HIV-infected patients with early syphilis, although some studies have suggested that a 3-dose regimen may be considered 5.