Treatment of Syphilis

The causative agent for syphilis is Treponema pallidum, a spirochete. Syphilis is still fairly common disease (it is a sexually transmitted disease), despite presence of very effective antibiotics such as penicillin. At present globally more than 10 million people contact syphilis, annually. But there is a sharp decline of more than 95% in the past 50 years in the incidence of syphilis after advent of penicillin therapy to treat syphilis effectively.

The antibiotic of choice for treatment of syphilis is still penicillin for all the stages of syphilis. There is no reported incidence of resistance of Treponema pallidum to penicillin and hence still the drug of choice.

The CDC has given a guideline for treatment of syphilis in the year 2006 which is given below:

  • Treatment of syphilis in Primary, secondary, and early latent phase of syphilis is Penicillin G benzathine (a single dose of 2.4 million units intramuscularly).
  • Late latent phase, or cardiovascular involvement, CSF (cerebrospinal fluid) analysis should be done. If CSF is normal Penicillin G benzathine 2.4 million units intramuscularly weekly for 3 weeks. If CSF is abnormal it should be treated as neurosyphilis.
  • Neurosyphilis, either symptomatic or asymptomatic is to be treated with aqueous penicillin G, 18–24 million units intravenously, given every 4 hourly (3–4 million units) or by continuous intravenous infusion. Alternative regimen is aqueous penicillin G procaine, 2.4 million units intramuscularly plus oral probenecid (500 mg every 6 hourly), both for 10–14 days.
  • During pregnancy the treatment is same as with general population and according to stages.
  • If patient is sensitive to penicillin, alternative includes Tetracycline hydrochloride (500 mg orally 4 times a day) or doxycycline (100 mg orally two times a day) for 14 days. Penicillin sensitive pregnant patients or patients with neurosyphilis have to be treated with penicillin after desensitization.
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