What is the treatment for secondary syphilis (Sexually Transmitted Disease)?

From the Guidelines

Secondary syphilis should be treated with a single intramuscular injection of benzathine penicillin G at a dose of 2.4 million units, as this is the most effective treatment for curing the infection and preventing progression to more serious tertiary stages. This recommendation is based on the most recent and highest quality study available, which demonstrates that additional doses of benzathine penicillin G, amoxicillin, or other antibiotics in early syphilis do not result in enhanced efficacy, regardless of HIV status 1.

Key Considerations

• The treatment of secondary syphilis is crucial to prevent the progression of the disease to more serious tertiary stages that can damage multiple organ systems.
• Penicillin is particularly effective against Treponema pallidum (the bacterium causing syphilis) because it disrupts cell wall synthesis during bacterial reproduction.
• For patients allergic to penicillin, alternative treatments include doxycycline 100 mg orally twice daily for 14 days, or tetracycline 500 mg orally four times daily for 14 days, although the efficacy of these therapies is not well documented and close follow-up is essential 1.
• Azithromycin is sometimes used but has shown resistance in some areas, and its use should be undertaken with caution, especially in HIV-infected persons.

Follow-up and Prevention

• After treatment, follow-up blood tests are necessary at 3,6, and 12 months to ensure the infection has been cleared.
• Sexual partners should also be tested and treated if necessary.
• Patients should abstain from sexual activity until treatment is complete and follow-up tests confirm cure.
• The use of any alternative therapies in HIV-infected persons must be undertaken with caution, as the efficacy of these therapies in this population is not well studied 1.

From the Research

Treatment Options for Secondary Syphilis

• The most effective antibiotic for treating secondary syphilis is penicillin, with benzathine penicillin G being a commonly used regimen 2.
• A single dose of 2.4 million units of benzathine penicillin G is considered an effective treatment for secondary syphilis 2, 3.
• Alternative treatments, such as ceftriaxone and doxycycline, have shown promise in treating early syphilis, including secondary syphilis, particularly in HIV-infected patients 4.
• Azithromycin has also been studied as a potential treatment for syphilis, with a single 2-g oral dose showing efficacy in treating early syphilis, including secondary syphilis 5.
• However, the use of azithromycin is limited due to reports of resistance 5, 6.

Special Considerations

• HIV-infected patients with secondary syphilis may require closer monitoring and potentially alternative treatment regimens 4, 3, 6.
• Patients with neurologic or ophthalmic symptoms should undergo cerebrospinal fluid (CSF) examination to rule out neurosyphilis 4, 6.
• CSF examination should also be considered in patients who do not achieve a ≥ 4-fold serologic decline in their rapid plasma reagin (RPR) titers after adequate therapy 6.

Treatment Efficacy

• The efficacy of different treatment regimens for secondary syphilis has been studied, with benzathine penicillin G remaining the most well-established treatment 2, 3, 6.
• Alternative treatments, such as ceftriaxone and doxycycline, have shown similar efficacy to benzathine penicillin G in some studies 4.
• Azithromycin has shown efficacy in treating early syphilis, but its use is limited due to resistance concerns 5.