Back to Basics: Syphilis Management
Management: treatment is primarily with penicillin with dosing and type of penicillin determined by stage of disease.
|
Stage |
Regimen |
Severe Penicillin Allergy* |
|
Primary, Secondary or Early Latent Syphilis |
Penicillin G Benzathine 2.4 million units IM x 1 Repeat dose in 7 days if (+)HIV or pregnant |
Doxycycline 100 mg BID x 14 days |
|
Tertiary Syphilis, Late Latent Syphilis |
Penicillin G Benzathine 2.4 million units IM x once per week for 3 weeks |
Doxycycline 100 mg BID x 28 days |
|
Neurosyphilis |
-Aqueous Crystalline Penicillin G 3-4 million units IV q4h x 10-14 days -Procaine Penicillin G 2.4 million units IM daily and Probenecid 500 mg QID x 10-14d |
Ceftriaxone 2g IV daily x 10-14 days |
*desensitization to penicillin allergy is still preferred method of treatment, especially for pregnant patients and neurosyphilis patients
**sexual partners from 90 days preceding the diagnosis should receive empiric syphilis treatment and have serologic testing
***all patients presenting with or diagnosed with syphilis should be tested for HIV
****Council patients on potential Jarisch-Herxheimer reaction
*****early latent is acquired within the past year; late latent is over 1 year