- Penicillin is the antibiotic of choice for syphilis, including treponema paraluiscuniculi infection.
*Primary, secondary or early-stage latent syphilis*
- Penicillin G benzathine, 2.4 million units IM as a single dose. (If patient is allergic to penicillin other treatments may be used.)
- Doxycycline, 100 mg orally 2 times a day for 14 days
- Tetracycline, 500 mg orally 4 times a day for 14 days
- Ceftriaxone, 1 g IM or IV daily for 10 to 14 days
*Late latent syphilis or syphilis of unknown duration*
- Either of the following:
- Penicillin G benzathine, 2.4 million units IM once a week for 3 consecutive weeks (total of 7.2 million units) or
- Doxycycline, 100 mg orally 2 times a day or tetracycline, 500 mg orally 4 times a day, both for 28 days
*Neurosyphilis*
- Aqueous crystalline penicillin G, 18 to 24 million U/day IV in divided doses q4h
*Congenital syphilis*
- Same regimen as for primary or secondary syphilis
- If cannot tolerate penicillin, may use:
- Procaine penicillin G, 50,000 U/kg IM every 12 hours for 10 to 14 days OR
- Aqueous penicillin G, 50,000 U/kg IV every 4 to 6 hours for 10 to 14 days
Retreatment
Patients with syphilis who are allergic to penicillin and failed other antibiotic regimens can be desensitized to penicillin and then treated with penicillin.
Follow-Up
Repeat serologic tests at 3 months, 6 months, and annually for at least 4 years. Follow until results are seronegative or stable (4-fold decrease in titer) for at least 6 months
Prevention
- All pregnant women and their partners and all sexually active adolescents should be screened as part of routine health care.
- Safe sex practices. Using latex condoms correctly and consistently during every act of sexual intercourse can markedly reduce the chances of acquiring or transmitting syphilis.
- Avoid contact with infectious lesions.