From the Guidelines
Ceftriaxone can be used as an effective treatment for syphilis, particularly in patients with penicillin allergies, with a recommended regimen of 1 g intravenous or intramuscular ceftriaxone for 10 days. This recommendation is based on a randomized trial that suggests comparable efficacy for treatment of early syphilis with ceftriaxone compared to benzathine penicillin G 1. The use of ceftriaxone is particularly useful in patients who are allergic to penicillin, as penicillin G is typically the first-line treatment for syphilis.
Key Considerations
- Ceftriaxone works by inhibiting bacterial cell wall synthesis, which is effective against Treponema pallidum, the bacterium that causes syphilis.
- Patients should be monitored for side effects such as pain at the injection site, gastrointestinal disturbances, and potential allergic reactions.
- Patients should complete the full course of treatment even if symptoms improve before completion.
- Follow-up serologic testing is essential after treatment to ensure the infection has been adequately treated.
- Sexual partners should also be evaluated and treated if necessary, and patients should abstain from sexual activity until treatment is complete and follow-up testing confirms cure.
Alternative Treatments
- Doxycycline and tetracycline are alternative treatments for syphilis, but ceftriaxone is a more effective option for patients with penicillin allergies 1.
- Azithromycin is not recommended as a first-line treatment due to concerns about macrolide resistance 1.
Treatment Outcomes
- The goal of treatment is to achieve complete resolution of symptoms and negative serologic test results.
- Patients should be followed up regularly to monitor treatment outcomes and adjust the treatment plan as needed 1.
From the Research
Ceftriaxone as a Treatment for Syphilis
- Ceftriaxone has been studied as a potential treatment for syphilis, with several studies indicating its effectiveness in treating the disease 2, 3, 4, 5, 6.
- A study from 1989 found that ceftriaxone was equivalent to penicillin G in treating primary and secondary syphilis, with no detectable difference in clinical and serological response 2.
- A 2017 study found that ceftriaxone was noninferior to benzathine penicillin G in treating early syphilis, with a serological response rate of 90.2% in the ceftriaxone group compared to 78.0% in the benzathine penicillin G group 3.
- Another study from 2012 found that ceftriaxone and doxycycline were suitable alternatives to penicillin in treating early syphilis, especially in HIV-infected patients 4.
- A review of syphilis treatment options in 1989 noted that ceftriaxone had promising results for early syphilis therapy, but the optimal dose and duration of therapy were unknown 5.
- A 2022 systematic review and network meta-analysis found that ceftriaxone had a higher serological response rate than penicillin at the 6-month follow-up, and was a better substitute for penicillin than other antibiotics 6.
Key Findings
- Ceftriaxone is effective in treating primary and secondary syphilis 2.
- Ceftriaxone is noninferior to benzathine penicillin G in treating early syphilis 3.
- Ceftriaxone and doxycycline are suitable alternatives to penicillin in treating early syphilis, especially in HIV-infected patients 4.
- Ceftriaxone has a higher serological response rate than penicillin at the 6-month follow-up 6.
Treatment Considerations
- Ceftriaxone may be a better alternative to penicillin for patients who are allergic to penicillin or for whom penicillin is not available 6.
- More large-scale, high-quality, double-blind trials are needed to determine whether ceftriaxone can safely replace penicillin for the treatment of syphilis when necessary 6.