Materiały źródłowe

• #1 Syphilis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/syphilis.htm

  Bicillin L-A is the first-line recommended treatment for syphilis and the only recommended treatment option for some patients. […] Penicillin G, administered parenterally, is the preferred drug for treating patients in all stages of syphilis. The preparation used (i.e., benzathine, aqueous procaine, or aqueous crystalline), dosage, and length of treatment depend on the stage and clinical manifestations of the disease. […] Parenteral penicillin G is the only therapy with documented efficacy for syphilis during pregnancy. Pregnant women with syphilis at any stage who report penicillin allergy should be desensitized and treated with penicillin. […] The Jarisch-Herxheimer reaction is an acute febrile reaction frequently accompanied by headache, myalgia, and fever that can occur within the first 24 hours after the initiation of any syphilis therapy; it is a reaction to treatment and not an allergic reaction to penicillin.

• #1 RECOMMENDATIONS FOR TREATMENT OF SYPHILIS – WHO Guidelines for the Treatment of Treponema pallidum (Syphilis) – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK384905/

  WHO Guidelines for the Treatment of Treponema pallidum (Syphilis). Geneva: World Health Organization; 2016. […] In adults and adolescents with early syphilis, the WHO STI guideline recommends benzathine penicillin G 2.4 million units once intramuscularly over no treatment. […] In adults and adolescents with early syphilis, the WHO STI guideline suggests using benzathine penicillin G 2.4 million units once intramuscularly over procaine penicillin G 1.2 million units 10-14 days intramuscularly. […] When benzathine or procaine penicillin cannot be used (e.g. due to penicillin allergy) or are not available (e.g. due to stock-outs), the WHO STI guideline suggests using doxycycline 100 mg twice daily orally for 14 days or ceftriaxone 1 g intramuscularly once daily for 10-14 days, or, in special circumstances, azithromycin 2 g once orally.

• #1 P&S Syphilis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/p-and-s-syphilis.htm

  Parenteral penicillin G has been used effectively for achieving clinical resolution (i.e., the healing of lesions and prevention of sexual transmission) and for preventing late sequelae. […] Recommended Regimen for Primary and Secondary Syphilis* Among Adults Benzathine penicillin G 2.4 million units IM in a single dose. […] Available data demonstrate that use of additional doses of benzathine penicillin G, amoxicillin, or other antibiotics do not enhance efficacy of this recommended regimen when used to treat primary and secondary syphilis, regardless of HIV status. […] Treatment should be guided by the results of these evaluations. […] Symptomatic neurosyphilis after treatment with the penicillin regimens recommended for primary and secondary syphilis is rare. […] Failure of nontreponemal test titers to decrease fourfold within 12 months after therapy for primary or secondary syphilis (inadequate serologic response) might be indicative of treatment failure.

• #1 Diagnosis and Management of Syphilis | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0715/p283.html/1000

  Early latent syphilis is treated in the same way as primary and secondary syphilis. […] Late latent syphilis is treated with 2.4 million units of penicillin G benzathine administered intramuscularly once a week for three weeks. […] Antibiotic therapy for gummatous and cardiovascular syphilis is the same as that for late latent syphilis, provided no evidence of neurologic involvement is present. […] Penicillin is the only drug that has proved effective in the treatment of neurosyphilis. […] The CDC endorses two regimens. The first is aqueous crystalline penicillin G, in a dosage of 3 to 4 million units administered intravenously every four hours for 10 to 14 days. The second regimen consists of penicillin G procaine, in a dosage of 2.4 million units administered intramuscularly once daily, plus probenecid, in a dosage of 500 mg orally four times daily, with both drugs given for 10 to 14 days.

• #1 Syphilis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534780/

  An alternative regimen for neurosyphilis would be procaine penicillin G 2.4 million units IM once daily, if available, AND Probenecid 500 mg orally 4 times per day for 10 to 14 days. An additional 1 to 3 weekly doses of 2.4 million units of benzathine penicillin G is considered optional to extend the duration of treatment in neurosyphilis. […] Doxycycline is not recommended for the treatment of neurosyphilis by the CDC or the European guidelines, although it is approved for this purpose in the UK. […] Patients must be followed posttreatment at 6, 12, and 24 months after therapy with a clinical evaluation and serial nontreponemal (VDRL and RPR) testing. In addition, re-examinations at 3 and 9 months are suggested for high-risk individuals. A 4-fold decline in nontreponemal test titers indicates successful treatment, while a 4-fold increase from the initial level suggests reinfection or therapy failure.

• #1 Diagnosis and Management of Syphilis | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0715/p283.html/1000

  Syphilis is a sexually transmitted disease with varied and often subtle clinical manifestations. […] Parenterally administered penicillin G is considered first-line therapy for all stages of syphilis. […] Alternative regimens for non-pregnant patients with no evidence of central nervous system involvement include doxycycline, tetracycline, ceftriaxone, and azithromycin. […] In pregnant women and patients with neurosyphilis, penicillin remains the only effective treatment option; if these patients are allergic to penicillin, desensitization is required before treatment is initiated. […] After appropriate treatment has been administered, patients should be followed with quantitative nontreponemal test titers to establish treatment response. […] The treatment of syphilis is similar in HIV-positive and HIV-negative patients.

• #1 RECOMMENDATIONS FOR TREATMENT OF SYPHILIS – WHO Guidelines for the Treatment of Treponema pallidum (Syphilis) – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK384905/

  In pregnant women with early syphilis, the WHO STI guideline recommends benzathine penicillin G 2.4 million units once intramuscularly over no treatment. […] In pregnant women with early syphilis, the WHO STI guideline suggests using benzathine penicillin G 2.4 million units once intramuscularly over procaine penicillin 1.2 million units intramuscularly once daily for 10 days. […] When benzathine or procaine penicillin cannot be used (e.g. due to penicillin allergy where penicillin desensitization is not possible) or are not available (e.g. due to stock-outs), the WHO STI guideline suggests using, with caution, erythromycin 500 mg orally four times daily for 14 days or ceftriaxone 1 g intramuscularly once daily for 10-14 days or azithromycin 2 g once orally. […] In adults and adolescents with late syphilis or unknown stage of syphilis, the WHO STI guideline recommends benzathine penicillin G 2.4 million units intramuscularly once weekly for three consecutive weeks over no treatment. […] In adults and adolescents with late syphilis or unknown stage of syphilis, the WHO STI guideline suggests benzathine penicillin G 2.4 million units intramuscularly once weekly for three consecutive weeks over procaine penicillin 1.2 million units once daily for 20 days. […] When benzathine or procaine penicillin cannot be used (e.g. due to penicillin allergy where penicillin desensitization is not possible) or are not available (e.g. due to stock-outs), the WHO STI guideline suggests using doxycycline 100 mg twice daily orally for 30 days.

• #1 Syphilis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534780/

  Adverse outcomes from maternal syphilis can be effectively prevented with a single IM injection of 2.4 million units of benzathine penicillin G administered before week 28 of gestation. This is 98% effective in eliminating congenital syphilis in the neonate but must be given 30 days or more prior to delivery. […] For further details on the treatment of syphilis, see the respective companion Statpearls’ references on „Sexually Transmitted Infections,” „Neurosyphilis,” „Congenital Syphilis,” and „Penicillin Allergy.”

• #1 RECOMMENDATIONS FOR TREATMENT OF SYPHILIS – WHO Guidelines for the Treatment of Treponema pallidum (Syphilis) – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK384905/

  In infants with confirmed congenital syphilis or infants who are clinically normal, but whose mothers had untreated syphilis, inadequately treated syphilis (including treatment within 30 days of delivery) or syphilis that was treated with non-penicillin regimens, the WHO STI guideline suggests aqueous benzyl penicillin or procaine penicillin. […] In infants who are clinically normal and whose mothers had syphilis that was adequately treated with no signs of reinfection, the WHO STI guideline suggests close monitoring of the infants.

• #1 Syphilis guide: Treatment and follow-up – Canada.ca

  https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/canadian-guidelines/syphilis/treatment-follow-up.html

  People who are treated with alternative treatments (e.g. doxycycline, ceftriaxone) may take longer to become non-infectious. These individuals should be advised to abstain from condomless sexual contact until treatment has been completed and ideally for seven (7) days after completion of treatment. The efficacy data supporting the use of these agents are limited and as such, they should only be used in exceptional circumstances and when close client follow-up is assured. […] Based on the serologic response to treatment, available data suggest that these individuals should receive the same treatment as people without HIV and that they will respond appropriately to single dose benzathine penicillin G-LA. Some experts recommend three (3) weekly doses (total of 7.2 million units) of benzathine penicillin G-LA in HIV-positive individuals.

• #1 Syphilis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/syphilis/diagnosis-treatment/drc-20351762

  Even if you’re treated for syphilis during your pregnancy, your newborn should be tested for congenital syphilis. A baby infected with the syphilis bacterium receives antibiotic treatment. […] After you’re treated for syphilis, your health care team likely will ask you to have regular blood tests and exams to make sure the penicillin treatment is working. The follow-up tests you need depend on the stage of syphilis you have. […] Do not have sexual contact with new partners until the treatment is finished. Blood tests should show that the infection has been cured, and any sores should be gone. […] If you think you might have syphilis, it’s best to not have any sexual contact until you’ve talked with your health care team.

• #1 Pediatric Syphilis Treatment & Management: Approach Considerations, Treatment of Neurosyphilis, Congenital Syphilis in Newborns

  https://emedicine.medscape.com/article/969023-treatment

  Treatment of co-infected individuals may require high-dose or prolonged therapy. […] The question of persistent infection despite adequate therapy has been controversial. […] The Jarisch-Herxheimer reaction is the major complication of therapy and occurs in 50% of patients with primary syphilis, in 90% of those with secondary syphilis, and in 25% of those with early latent syphilis. […] Although rates of early syphilis are declining, maintaining a high index of suspicion about at-risk patients is important. […] Given the protean manifestations of syphilis, consultation with a range of specialists may be valuable, such as the following. […] Congenital syphilis requires follow-up at age 1 month, 2 months, 4 months, 6 months, and 12 months. Obtain nontreponemal titers at age 3 months, 6 months, and 12 months after conclusion of treatment.

• #1 Syphilis (for Teens) | Nemours KidsHealth

  https://kidshealth.org/en/teens/std-syphilis.html

  Syphilis is a sexually transmitted disease (STD). Early treatment can cure syphilis and prevent long-term problems. […] Health care providers treat syphilis with antibiotics. These medicines are given as a shot or through an IV (a tiny tube that goes into a vein). How long treatment is needed depends on what stage of syphilis someone is in. […] Syphilis can be cured. But the medical problems it can lead to such as dementia, artery damage, or blindness usually can’t be cured. […] After treatment, follow-up testing will make sure that the infection is cured. […] All sexual partners should get tested and treated, if necessary: For primary syphilis: partners from the last 3 months; For secondary syphilis: partners from the last 6 months; For latent syphilis: partners from the last year (because there could have been a chancre or condyloma lata that wasn’t noticed).

• #1 Syphilis Treatment & Management: Approach Considerations, Antibiotic Therapy, Surgical Care

  https://emedicine.medscape.com/article/229461-treatment

  A meta-analysis of randomized clinical trials comparing azithromycin to benzathine penicillin G for early syphilis was published in 2008 showing favorable results for azithromycin. […] Management of this reaction often involves symptomatic treatment (eg, with antipyretics and analgesics) and observation. […] Surgical care is reserved for treating the complications of tertiary syphilis (eg, aortic valve replacement). […] The primary goal of prevention is to limit the spread of syphilis. […] Empiric treatment with one dose of benzathine penicillin G 2.4 million units intramuscularly (IM) is recommended in all patients who have had sexual contact with a partner who has tested positive for primary, secondary, or early latent syphilis within the preceding 90 days. […] Monitor patients with syphilis to ensure adequacy of treatment. […] Patients with early syphilis should be monitored with repeat RPR or VDRL at 6- and 12-month intervals. […] Patients with latent syphilis should be monitored with RPR or VDRL at 6-, 12-, and 24-month intervals.

• #1 Syphilis guide: Treatment and follow-up – Canada.ca

  https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/canadian-guidelines/syphilis/treatment-follow-up.html

  Advise people who are treated with single dose benzathine penicillin G -LA to abstain from condomless sexual contact for seven (7) days post treatment to provide a margin of safety. […] Treatment response is evaluated based on the clinical picture and NTT titre changes. Monitor NTTs at intervals until they revert to negative or are at a stable low titre (e.g. 1:4 dilutions). […] Serologic decline in NTT following treatment is variable and definitive criteria for cure or treatment failure have not been well established.

• #1 Amoxicillin Treatment for Syphilis: Can an Old Drug Learn a New Trick?

  https://www.contagionlive.com/view/amoxicillin-treatment-for-syphilis-can-an-old-drug-learn-a-new-trick-

  As a low-cost oral regimen, amoxicillin with probenecid may provide advantages for select patients. […] Alternative treatment options are particularly vital when managing medication shortages and as of April 2023 there is an ongoing shortage of BPG in the United States due to increased demand for the medication. […] Further prospective studies of amoxicillin/probenecid regimens for syphilis treatment in people without HIV and women should be conducted to optimize the dosing regimen and demonstrate safety and effectiveness in a diverse patient population.

• #1 Syphilis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/syphilis/symptoms-causes/syc-20351756

  Early syphilis can be cured, sometimes with a single shot of medicine called penicillin. […] Syphilis is preventable and treatable. […] A medicine called doxycycline may be an option to prevent infection among people who have a higher risk than average of getting syphilis. […] Taking doxycycline within 3 days of sexual activity lowers the risk of an infection with the bacteria that cause syphilis.

• #1 Syphilis: Cause, Symptoms, Diagnosis, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/4622-syphilis

  Syphilis is a sexually transmitted infection (STI) thats treatable with medication. […] Antibiotic medication treats syphilis. […] Your healthcare provider treats syphilis with antibiotics. Antibiotics are a type of medication that treats bacterial infections. Penicillin is the most commonly used medication for syphilis. […] Yes. Your healthcare provider can treat syphilis with antibiotics. Antibiotics will cure the infection, but theres no way to repair organs damaged by syphilis. […] Syphilis is a treatable STI. Its important to get tested so you can get treatment in the early stages of the infection.

• #1 Syphilis: Symptoms, Diagnosis, Treatment, and Prevention

  https://www.healthline.com/health/std/syphilis

  Syphilis is caused by the bacteria Treponema pallidum and is transmitted through sexual contact. […] Treatments are so well established that, at one point, it was thought possible to eradicate syphilis completely. […] Lets go over what we know about syphilis, who is most at risk, and what the standard treatments for it are today. […] Penicillin is the main treatment for syphilis during pregnancy. […] Primary and secondary syphilis are easy to treat with a penicillin injection. […] If you have neurosyphilis, you’ll get daily doses of penicillin intravenously. […] The damage caused by late syphilis can’t be reversed. […] The bacteria can be killed, but treatment will most likely focus on easing pain and discomfort. […] If the test comes back positive, it’s important to complete the full treatment. […] Make sure to finish the full course of antibiotics, even if symptoms disappear. […] Yes, syphilis can be cured. The bacterial infection can be resolved by undergoing a full treatment regimen of prescription antibiotics.

• #2 Syphilis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/syphilis/diagnosis-treatment/drc-20351762

  You may be able to use a test that’s available without a prescription, sometimes called an at-home test, to see if you have syphilis. If that test shows you have syphilis, you’ll need to see a healthcare professional to confirm the diagnosis and start treatment. […] Syphilis is simple to cure when it’s found and treated in its early stages. The preferred treatment at all stages is penicillin. This antibiotic medicine can kill the bacteria that causes syphilis. […] The recommended treatment for primary, secondary or early-stage latent syphilis is a single shot of penicillin. If you’ve had syphilis for longer than a year, you may need additional doses. […] Penicillin is the only recommended treatment for pregnant people with syphilis. Those who are allergic to penicillin can follow a process that may allow them to take the medicine. The procedure is called penicillin desensitization.

• #2 Syphilis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534780/

  Penicillin is the preferred bacteriocidal antibiotic for all stages of syphilis. It is most effective when bacteria are quickly reproducing. Treponema spp divide only once every 30 hours, so longer-acting forms of the antibiotic are typically preferred (procaine and benzathine penicillin), except for neurosyphilis where aqueous formulations are recommended as they can attain higher CSF concentrations. […] Treatment of syphilis depends on the disease stage, as recommended by the CDC as follows: Primary, secondary, and early latent syphilis are treated with a single dose of intramuscular (IM) benzathine penicillin G 2.4 million units. Tertiary, late latent syphilis, and HIV-infected patients with the disease should be treated with 2.4 million units of benzathine penicillin G IM weekly for 3 weeks. Neurosyphilis, including ocular disease and otosyphilis, should be treated with IV aqueous crystalline penicillin G 18 million to 24 million units (as a continuous IV infusion or 3 to 4 million units IV every 4 hours) daily for 10 to 14 days.

• #2 RECOMMENDATIONS FOR TREATMENT OF SYPHILIS – WHO Guidelines for the Treatment of Treponema pallidum (Syphilis) – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK384905/

  In pregnant women with early syphilis, the WHO STI guideline recommends benzathine penicillin G 2.4 million units once intramuscularly over no treatment. […] In pregnant women with early syphilis, the WHO STI guideline suggests using benzathine penicillin G 2.4 million units once intramuscularly over procaine penicillin 1.2 million units intramuscularly once daily for 10 days. […] When benzathine or procaine penicillin cannot be used (e.g. due to penicillin allergy where penicillin desensitization is not possible) or are not available (e.g. due to stock-outs), the WHO STI guideline suggests using, with caution, erythromycin 500 mg orally four times daily for 14 days or ceftriaxone 1 g intramuscularly once daily for 10-14 days or azithromycin 2 g once orally. […] In adults and adolescents with late syphilis or unknown stage of syphilis, the WHO STI guideline recommends benzathine penicillin G 2.4 million units intramuscularly once weekly for three consecutive weeks over no treatment. […] In adults and adolescents with late syphilis or unknown stage of syphilis, the WHO STI guideline suggests benzathine penicillin G 2.4 million units intramuscularly once weekly for three consecutive weeks over procaine penicillin 1.2 million units once daily for 20 days. […] When benzathine or procaine penicillin cannot be used (e.g. due to penicillin allergy where penicillin desensitization is not possible) or are not available (e.g. due to stock-outs), the WHO STI guideline suggests using doxycycline 100 mg twice daily orally for 30 days.

• #2 Syphilis: CDC Diagnosis and Treatment Guidelines – PcMED Project

  https://pcmedproject.com/id/syphilis-cdc-diagnosis-and-treatment-guidelines/

  For tertiary syphilis, treatment includes Benzathine penicillin G 7.2 million units administered as 3 weekly doses of 2.4 million units. […] For neurosyphilis, treatment includes Aqueous crystalline penicillin G, 3 to 4 million units IV every 4 hours for 10 to 14 days or penicillin G procaine, 2.4 million units IM daily plus probenicid 500 mg orally 4 times daily, for 10 to 14 days. […] Patients with penicillin allergy should be desensitized and treated with penicillin whenever possible. Doxycycline 100 mg BID x 14 days or tetracycline 500 mg 4 times daily for 14 days can be used for nonpregnant penicillin-allergic patients with primary or secondary syphilis. […] Nontreponemal titers decline after treatment and eventually become negative. Treponemal tests remain positive for life. Follow-up at 6, 12, 18 and 24 months after therapy should include serology. If symptoms persist or recur, or there is a >4 fold increase in nontreponemal test titer persisting more than 2 weeks, consider reinfection or treatment failure.

• #2 Syphilis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534780/

  An alternative regimen for neurosyphilis would be procaine penicillin G 2.4 million units IM once daily, if available, AND Probenecid 500 mg orally 4 times per day for 10 to 14 days. An additional 1 to 3 weekly doses of 2.4 million units of benzathine penicillin G is considered optional to extend the duration of treatment in neurosyphilis. […] Doxycycline is not recommended for the treatment of neurosyphilis by the CDC or the European guidelines, although it is approved for this purpose in the UK. […] Patients must be followed posttreatment at 6, 12, and 24 months after therapy with a clinical evaluation and serial nontreponemal (VDRL and RPR) testing. In addition, re-examinations at 3 and 9 months are suggested for high-risk individuals. A 4-fold decline in nontreponemal test titers indicates successful treatment, while a 4-fold increase from the initial level suggests reinfection or therapy failure.

• #2 Diagnosis and Management of Syphilis | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0715/p283.html/1000

  Syphilis is a sexually transmitted disease with varied and often subtle clinical manifestations. […] Parenterally administered penicillin G is considered first-line therapy for all stages of syphilis. […] Alternative regimens for non-pregnant patients with no evidence of central nervous system involvement include doxycycline, tetracycline, ceftriaxone, and azithromycin. […] In pregnant women and patients with neurosyphilis, penicillin remains the only effective treatment option; if these patients are allergic to penicillin, desensitization is required before treatment is initiated. […] After appropriate treatment has been administered, patients should be followed with quantitative nontreponemal test titers to establish treatment response. […] The treatment of syphilis is similar in HIV-positive and HIV-negative patients.

• #2 Syphilis Treatment & Management: Approach Considerations, Antibiotic Therapy, Surgical Care

  https://emedicine.medscape.com/article/229461-treatment

  Late latent syphilis or latent syphilis of unknown duration – Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervals. […] In patients with a history of penicillin allergy, desensitization may be necessary in cases of pregnancy, neurosyphilis, congenital syphilis, or tertiary syphilis. […] According to the 2015 CDC STD guidelines, no treatment regimens for syphilis have been shown to be more effective in preventing neurosyphilis in patients who are HIV positive than the syphilis regimens recommended for patients who are HIV negative. […] As stated in the 2015 CDC guidelines, several therapies exist that might be effective in nonpregnant, penicillin-allergic patients with primary or secondary syphilis. […] Doxycycline and tetracycline for 28 days have been used for many years and are the only acceptable alternatives to penicillin for the treatment of latent syphilis.

• #2 Screening for Syphilis in Pregnancy | ACOG

  https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2024/04/screening-for-syphilis-in-pregnancy

  Benzathine penicillin G is the only known effective treatment for syphilis in pregnancy and the prevention of congenital syphilis. […] Timely initiation and completion of treatment are imperative and often complicated by stigma, multiple injections, treatment shortages, reporting and follow-up requirements, and mistrust of the medical system. […] In patients with a known severe allergy to penicillin, desensitization followed by penicillin treatment is recommended. […] There is currently a shortage of benzathine penicillin G, sold as Bicillin L-A. […] The U.S. Food and Drug Administration has exercised enforcement discretion for the temporary importation and use of Extencilline (benzathine benzylpenicillin injection, powder, for suspension) to mitigate the effects of the Bicillin L-A drug shortage. […] When needed, local health departments, disease intervention specialists, and trusted community organizations can play an important role in helping people and their sex partners overcome barriers to accessing and completing treatment.

• #2 Pediatric Syphilis Treatment & Management: Approach Considerations, Treatment of Neurosyphilis, Congenital Syphilis in Newborns

  https://emedicine.medscape.com/article/969023-treatment

  The recommended dosage is 100,000-150,000 U/kg/d IV every 8-12 hours to complete a 10-day to 14-day course. […] Treat all pregnant patients with syphilis with penicillin, regardless of the stage of pregnancy. Administer 3 doses of benzathine penicillin (2.4 million U IM at 1-wk intervals). […] No proven alternative therapy is available for patients who are allergic to penicillin. Erythromycin treatment for pregnant patients who are allergic to penicillin is not a reliable treatment for the fetus. […] For primary, secondary, or latent syphilis that is less than a year’s duration, a single dose of IM benzathine penicillin G in a total dose of 50,000 U/kg (not to exceed 2.4 million U) is the recommended treatment. […] For syphilis of longer than 1 year in duration, the recommended treatment is benzathine penicillin G, 50,000 U/kg IM (not to exceed 2.4 million U) weekly for 3 successive weeks.

• #2 Congenital Syphilis Treatment Guidelines

  https://dph.illinois.gov/topics-services/diseases-and-conditions/stds/syphilis/action-toolkit/congenital-syphilis-treatment-guidelines.html

  Neonates born to an individual who has reactive nontreponemal serologic tests for syphilis at delivery should be examined thoroughly for evidence of congenital syphilis. […] Maternal history of infection with T. pallidum and treatment for syphilis should be considered when evaluating and treating the neonate for congenital syphilis in most scenarios, except when congenital syphilis is proven or highly probable. […] Aqueous crystalline penicillin G 100,000150,000 units/kg body weight/day, administered as 50,000 units/kg body weight/dose by IV every 12 hours during the first seven days of life and every eight hours thereafter for a total of 10 days. […] Procaine penicillin G 50,000 units/kg body weight/dose IM in a single daily dose for 10 days. […] If 1 day of therapy is missed, the entire course should be restarted.

• #2 Syphilis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/syphilis/diagnosis-treatment/drc-20351762

  Even if you’re treated for syphilis during your pregnancy, your newborn should be tested for congenital syphilis. A baby infected with the syphilis bacterium receives antibiotic treatment. […] After you’re treated for syphilis, your health care team likely will ask you to have regular blood tests and exams to make sure the penicillin treatment is working. The follow-up tests you need depend on the stage of syphilis you have. […] Do not have sexual contact with new partners until the treatment is finished. Blood tests should show that the infection has been cured, and any sores should be gone. […] If you think you might have syphilis, it’s best to not have any sexual contact until you’ve talked with your health care team.

• #2 Syphilis: Adult and Adolescent OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/syphilis

  Syphilis, caused by Treponema pallidum, is associated with an increased risk of sexual acquisition and transmission of HIV. In the United States, the national rate of primary and secondary syphilis has increased since 2001. Although HIV infection, particularly in the advanced stages, may modify the diagnosis, natural history, or management of T. pallidum infection, the principles of syphilis management remain the same for people with and without HIV. […] The efficacy of non-penicillin alternatives has not been well evaluated in people with HIV and should be undertaken only with close clinical and serologic monitoring. […] Benzathine penicillin G remains the treatment of choice for syphilis. People with HIV with early-stage (primary, secondary, or early latent) syphilis should receive a single intramuscular (IM) injection of 2.4 million units of benzathine penicillin G.

• #2 Syphilis guide: Treatment and follow-up – Canada.ca

  https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/canadian-guidelines/syphilis/treatment-follow-up.html

  Advise people who are treated with single dose benzathine penicillin G -LA to abstain from condomless sexual contact for seven (7) days post treatment to provide a margin of safety. […] Treatment response is evaluated based on the clinical picture and NTT titre changes. Monitor NTTs at intervals until they revert to negative or are at a stable low titre (e.g. 1:4 dilutions). […] Serologic decline in NTT following treatment is variable and definitive criteria for cure or treatment failure have not been well established.

• #2 Syphilis Treatment & Management: Approach Considerations, Antibiotic Therapy, Surgical Care

  https://emedicine.medscape.com/article/229461-treatment

  A meta-analysis of randomized clinical trials comparing azithromycin to benzathine penicillin G for early syphilis was published in 2008 showing favorable results for azithromycin. […] Management of this reaction often involves symptomatic treatment (eg, with antipyretics and analgesics) and observation. […] Surgical care is reserved for treating the complications of tertiary syphilis (eg, aortic valve replacement). […] The primary goal of prevention is to limit the spread of syphilis. […] Empiric treatment with one dose of benzathine penicillin G 2.4 million units intramuscularly (IM) is recommended in all patients who have had sexual contact with a partner who has tested positive for primary, secondary, or early latent syphilis within the preceding 90 days. […] Monitor patients with syphilis to ensure adequacy of treatment. […] Patients with early syphilis should be monitored with repeat RPR or VDRL at 6- and 12-month intervals. […] Patients with latent syphilis should be monitored with RPR or VDRL at 6-, 12-, and 24-month intervals.

• #2 Syphilis: Adult and Adolescent OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/syphilis

  The Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV supports the use of doxycycline, 100 mg orally twice daily for 14 days, to treat early syphilis. […] People with HIV who have late latent syphilis, treatment with three weekly IM injections of 2.4 million units of benzathine penicillin G is recommended. […] People with HIV diagnosed with neurosyphilis or ocular or otic syphilis should receive IV aqueous crystalline penicillin G, 18 to 24 million units daily, administered 3 to 4 million units IV every 4 hours or by continuous infusion for 10 to 14 days. […] Treatment regimens for syphilis demonstrate that most people with HIV respond appropriately to single dose benzathine penicillin G after exposure to syphilis and for primary, secondary, and early latent syphilis (within the previous 12 months). […] The Jarisch-Herxheimer reaction is an acute febrile reaction frequently accompanied by headache, rigors, transient worsening of rash, myalgia, and sometimes even a sepsis-like syndrome, that can occur within the first 24 hours after initiation of treatment for syphilis.

• #2 Syphilis Cure: Symptoms, Sores & Treatment for Men & Women

  https://www.emedicinehealth.com/syphilis/article_em.htm

  A pregnant woman with syphilis must have penicillin, even if she is allergic to it. She must tell her doctor of this allergy to allow for desensitization procedures. […] After treatment with penicillin, a Jarisch-Herxheimer reaction may occur 2-12 hours after treatment starts. This reaction is the result of the dying bacteria and may cause previous symptoms to transiently worsen. Alarming as it may be, this reaction usually ends within 24 hours. Bed rest, pain relievers (such as aspirin, acetaminophen, or ibuprofen), and liquids can help.

• #2 Syphilis treatment guidelines – Melbourne Sexual Health Centre (MSHC)

  https://www.mshc.org.au/health-professionals/treatment-guidelines/syphilis-treatment-guidelines

  Procaine penicillin G 1.0 g IM, daily 15 days […] Doxycycline 100 mg twice daily for 28 days (if allergic to penicillin and not pregnant) […] The possibility of neurosyphilis should always be considered in the differential diagnosis of neurological disease in HIV infection. […] Case reports have suggested that treatment failures may be more common when syphilis occurs in HIV positive patients. […] Partner notification should be discussed with patients diagnosed with syphilis as sex with untreated, infected partners can result in reinfection. […] Individuals who report sexual contact with a person with syphilis should be treated with a single dose of benzathine penicillin without waiting for the results of serology.

• #2 Syphilis: Symptoms, Causes, Diagnosis, Treatment

  https://www.webmd.com/sexual-conditions/syphilis

  You should not take doxycycline if you’re pregnant. Your doctor will decide what medication is best for you based on your case. […] Don’t engage in any sexual activity until you’ve completed treatment with antibiotics and tests show that you are no longer infected. Wait until your partner has finished treatment to prevent reinfection.

• #2 Syphilis | STI Guidelines Australia

  https://sti.guidelines.org.au/sexually-transmissible-infections/syphilis/

  There is currently a shortage of both strengths of Bicillin L-A (benzathine benzylpenicillin tetrahydrate) prefilled syringes for injection (600,000 units per syringe and 1.2 million units per syringe). The shortage is expected to last into 2025. During the shortage, the TGA have approved an overseas registered product, Extencilline benzathine benzylpenicillin 1.2 million unit vial (France), under section 19A of the Therapeutic Goods Act 1989. […] GPs should be aware their community pharmacies may not have supply of Benzylpenicillin Benzathine (Brancaster) and they may need to be proactive in ensuring access for their patients from local hospitals and publicly funded sexual health services. […] Early referral or discussion with a specialist is strongly recommended. […] Patients being treated for primary and secondary syphilis should have RPR serology repeated on the day treatment is commenced to provide an accurate baseline for monitoring treatment response.

• #2 Syphilis: antibiotic treatment and resistance | Epidemiology & Infection | Cambridge Core

  https://www.cambridge.org/core/journals/epidemiology-and-infection/article/syphilis-antibiotic-treatment-and-resistance/D8519DE049A3F96B18C7F29A50E5D437

  However, it is unknown if these treatment failures were due to erythromycin-resistant T. pallidum since macrolides may not efficiently cross the placental barrier. […] Despite documented erythromycin resistance in T. pallidum Street strain 14, there was considerable enthusiasm early on for the use of azithromycin for treatment of syphilis, particularly for resource-limited settings where the burden of syphilis is high and the use of injectable drugs is problematic. […] However, during 2002-2003, treatment failures were observed in eight patients in San Francisco, California. […] Macrolide-resistant T. pallidum with the A2058G mutation is now present in several areas of the USA, Canada, Europe, and China and has been reported recently in Sydney, Australia. […] Addressing the resurgence of syphilis and the emergence of macrolide-resistant T. pallidum will require effort on several fronts.

• #2 Syphilis Treatment Options: After Exposure Vs. After A Positive …

  https://stdcenterny.com/articles/syphilis-postexposure-treatment.html

  Syphilis treatment options: after exposure vs. after a positive test […] Though syphilis is potentially life-threatening, it is easily treated if diagnosed early. […] Anyone who may have had sexual intercourse with a syphilis-positive partner can get post-exposure prophylaxis for syphilis: […] Shot of penicillin (within 3 months of exposure) […] Tablets of doxycycline (within 24 hours of exposure) in order to prevent the development of the disease […] You can be treated for syphilis before or after you test positive for it, and people choose differently depending on their circumstances. […] Two doxycycline (100 mg) oral tablets taken within 24 hours of sexual intercourse may decrease the risk of syphilis acquisition by over 73%. […] The effectiveness of post-exposure prophylactic medication varies depending on the treatment option.

• #2

  https://www.who.int/news-room/fact-sheets/detail/syphilis

  Syphilis is treatable and curable. People who suspect they may have syphilis should speak to their healthcare provider. […] The early stage of syphilis is treated with a benzathine penicillin (BPG) injection. BPG is the first line treatment for syphilis and the only WHO-recommended treatment for pregnant women with syphilis. As second line treatment, doctors may also use doxycycline, ceftriaxone or azithromycin, which are antibiotic medicines. […] BPG can prevent syphilis from being passed from a mother to baby. Babies born with syphilis (congenital syphilis), or babies whose mother had untreated syphilis, need to be treated right away to avoid serious health problems. […] WHO has also developed treatment guidelines for syphilis and another guideline for testing and treatment of syphilis specific for pregnancy. These include the recommendation for the use of the dual HIV/syphilis test which is affordable, effective and cost-effective in some settings and context.

• #2 Syphilis: Symptoms, treatment, is it curable, and diagnosis

  https://www.medicalnewstoday.com/articles/186656

  Syphilis is curable and antibiotics can resolve it in the early stages. […] Syphilis is treatable with antibiotics, especially in the early stages. It does not resolve without treatment. […] Anyone who is worried that they might have syphilis or another sexually transmitted infection (STI) should speak to a doctor as soon as possible, as prompt treatment can cure it. […] Early treatment with penicillin is important, as the disease can lead to life threatening consequences in the long term. […] At a later stage, syphilis remains curable. However, a person may require a longer course of penicillin. […] Treatment for syphilis can be successful, particularly in the early stages. […] The treatment strategy will depend on the symptoms and how long a person has harbored the bacteria. However, during the primary, secondary, or tertiary stage, people with syphilis typically receive an intramuscular injection of penicillin G benzathine.

• #3 Syphilis: Cause, Symptoms, Diagnosis, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/4622-syphilis

  Syphilis is a sexually transmitted infection (STI) thats treatable with medication. […] Antibiotic medication treats syphilis. […] Your healthcare provider treats syphilis with antibiotics. Antibiotics are a type of medication that treats bacterial infections. Penicillin is the most commonly used medication for syphilis. […] Yes. Your healthcare provider can treat syphilis with antibiotics. Antibiotics will cure the infection, but theres no way to repair organs damaged by syphilis. […] Syphilis is a treatable STI. Its important to get tested so you can get treatment in the early stages of the infection.

• #3 Diagnosis and Management of Syphilis | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0715/p283.html/1000

  Syphilis is a sexually transmitted disease with varied and often subtle clinical manifestations. […] Parenterally administered penicillin G is considered first-line therapy for all stages of syphilis. […] Alternative regimens for non-pregnant patients with no evidence of central nervous system involvement include doxycycline, tetracycline, ceftriaxone, and azithromycin. […] In pregnant women and patients with neurosyphilis, penicillin remains the only effective treatment option; if these patients are allergic to penicillin, desensitization is required before treatment is initiated. […] After appropriate treatment has been administered, patients should be followed with quantitative nontreponemal test titers to establish treatment response. […] The treatment of syphilis is similar in HIV-positive and HIV-negative patients.

• #3 Syphilis: Symptoms, Causes, and Treatments > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/syphilis

  Treatment includes antibiotics […] With early detection and treatment, syphilis can be cured before it causes irreversible damage to organs. […] The bacteria can be completely cleared from the body using penicillin or, less commonly, other antibiotics such as doxycycline, tetracycline, or ceftriaxone. […] Primary, secondary, and early latent syphilis are treated with a single shot of penicillin. […] Late latent and tertiary syphilis without neurosyphilis are treated with three doses of penicillin given by injection at one-week intervals. […] Neurosyphilis, ocular syphilis, and otosyphilis are treated with a 10- to 14-day course of intravenous (IV) antibiotics. […] Pregnant women are treated with penicillin, the only antibiotic known to effectively treat the fetus and prevent congenital syphilis. […] After treatment, periodic blood tests at six months and one year after treatment are needed to confirm that the infection has cleared. […] In the early stages (primary, secondary, or early latent syphilis), the disease is usually curable with appropriate antibiotic treatment.

• #3 Syphilis: CDC Diagnosis and Treatment Guidelines – PcMED Project

  https://pcmedproject.com/id/syphilis-cdc-diagnosis-and-treatment-guidelines/

  Syphilis: CDC Diagnosis and Treatment Guidelines […] Syphilis is a sexually transmitted infection caused by Treponema pallidum. Symptoms, diagnostic tests and treatment vary depending on stage of the disease. Without treatment, syphilis can damage the brain, nerves, eyes, and cardiovascular system. […] Diagnosis requires both a (1) nontreponemal test (VDRL or RPR) and (2) a treponemal test (FTA-ABS, EIA, CIAs and immunoblots, rapid treponemal tests or TP-PA). […] Treatment for primary syphilis includes Benzathine penicillin G 2.4 million units IM in a single dose. […] Treatment for secondary syphilis is the same as for primary syphilis. […] For early latent syphilis (acquired within 1 yr), treatment is Benzathine penicillin G 2.4 million units IM single dose. For late latent syphilis (acquired > 1 yr), treatment is Benzathine penicillin G 7.2 million units total given IM in 3 weekly doses of 2.4 million units each.

• #3 Syphilis Treatment & Management: Approach Considerations, Antibiotic Therapy, Surgical Care

  https://emedicine.medscape.com/article/229461-treatment

  Penicillin is the drug of choice to treat syphilis. […] Doxycycline is the best alternative for treating early and late latent syphilis. Syphilis associated with HIV infection does not require any enhanced antimicrobial therapy. […] Penicillin remains the mainstay of treatment and the standard by which other modes of therapy are judged. […] The 2015 CDC STD treatment guidelines support the use of penicillin as the preferred drug for treating all stages of syphilis. […] Penicillin is the only recommended therapy for neurosyphilis, congenital syphilis, or syphilis during pregnancy. […] The following regimens are recommended for penicillin treatment: Primary or secondary syphilis – Benzathine penicillin G 2.4 million units intramuscularly (IM) in a single dose. […] Early latent syphilis – Benzathine penicillin G 2.4 million units IM in a single dose.

• #3 Syphilis | Georgia Department of Public Health

  https://dph.georgia.gov/STDs/information-about-stds/syphilis

  Neurosyphilis and syphilis affecting the eyes or ears require more specific management. The recommended treatment is aqueous crystalline penicillin G 18-24 million daily units, administered as 3-4 million units IV every four hours for 10-14 days. […] For those allergic to penicillin, alternative treatments include doxycycline or tetracycline for non-pregnant patients. Multiple therapies might be effective for nonpregnant persons with penicillin allergy who have primary or secondary syphilis.

• #3 Syphilis: antibiotic treatment and resistance | Epidemiology & Infection | Cambridge Core

  https://www.cambridge.org/core/journals/epidemiology-and-infection/article/syphilis-antibiotic-treatment-and-resistance/D8519DE049A3F96B18C7F29A50E5D437

  Due to possible resistance, azithromycin must only be used when treatment with penicillin or doxycycline is not feasible. […] Data to support the use of second-line drugs for syphilis treatment are limited. […] According to CDC guidelines, men and non-pregnant women with early syphilis who are allergic to penicillin may be treated with doxycycline (100 mg orally, twice daily for 14 days); tetracycline (500 mg orally, four times daily for 14 days) or ceftriaxone [1 g intramuscularly (i.m.) or intravenously (i.v.), once daily for 10-14 days]. […] Close follow-up of patients receiving second-line therapy is absolutely essential since treatment failure can extend the window of opportunity for transmission of syphilis. […] The need for deep i.m. injection of benzathine penicillin, which is painful, and the possibility of a severe allergic reaction to penicillin has led some clinicians to use second-line oral antibiotics, including macrolides (e.g. erythromycin, azithromycin, clarithromycin, spiromycin) and tetracyclines (e.g. tetracycline, doxycycline) as first-line drugs for treatment of early syphilis.

• #3 P&S Syphilis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/p-and-s-syphilis.htm

  For retreatment, weekly injections of benzathine penicillin G 2.4 million units intramuscularly (IM) for 3 weeks is recommended, unless CSF examination indicates that neurosyphilis is present. […] Data to support use of alternatives to penicillin in treating primary and secondary syphilis are limited. […] However, multiple therapies might be effective for nonpregnant persons with penicillin allergy who have primary or secondary syphilis. […] Pregnant women with primary or secondary syphilis who are allergic to penicillin should be desensitized and treated with penicillin G. […] Persons with HIV infection who have primary or secondary syphilis should be treated similarly to those without HIV.

• #3 How Syphilis Is Treated

  https://www.verywellhealth.com/treatments-for-syphilis-2329063

  Penicillin desensitization is used to make a person less sensitive to penicillin. […] Penicillin G is the mainstay of treatment for syphilis. Depending on the stage of infection and other factors, the preparation, dose, and duration of therapy can vary. If penicillin G cannot be used due to a penicillin allergy, other antibiotics may be prescribed. […] The sexual partners of someone with syphilis should also be treated. […] Surgery is sometimes needed for people with complications of tertiary syphilis, such as an aortic aneurysm or a brain mass known as a cerebral syphilitic gumma.

• #3 Congenital Syphilis Treatment Guidelines

  https://dph.illinois.gov/topics-services/diseases-and-conditions/stds/syphilis/action-toolkit/congenital-syphilis-treatment-guidelines.html

  Aqueous crystalline penicillin G 100,000150,000 units/kg body weight/day, administered as 50,000 units/kg body weight/dose by IV every 12 hours during the first seven days of life and every eight hours thereafter for a total of 10 days. […] Procaine penicillin G 50,000 units/kg body weight/dose IM in a single daily dose for 10 days. […] Benzathine penicillin G 50,000 units/kg body weight/dose IM in a single dose. […] If any part of the neonates evaluation is abnormal or not performed, if the CSF analysis is uninterpretable because of contamination with blood, or if follow-up is uncertain, a 10-day course of penicillin G is required. […] Benzathine penicillin G 50,000 units/kg body weight/dose IM in a single dose. […] Benzathine penicillin G 50,000 units/kg body weight as a single IM injection might be considered, particularly if follow-up is uncertain and the neonate has a reactive nontreponemal test.

• #3 Diagnosis and Management of Syphilis | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0715/p283.html

  The treatment of syphilis is similar in HIV-positive and HIV-negative patients. […] After appropriate treatment has been administered, patients should be followed with quantitative nontreponemal test titers to establish treatment response. […] Primary syphilis is treated with 2.4 million units of penicillin G benzathine delivered intramuscularly in a single dose. […] In nonpregnant patients who are allergic to penicillin, alternative regimens include doxycycline (Vibramycin), in a dosage of 100 mg taken orally twice daily for two weeks, or tetracycline, in a dosage of 500 mg taken orally four times daily for two weeks. […] Antibiotic therapy for gummatous and cardiovascular syphilis is the same as that for late latent syphilis, provided no evidence of neurologic involvement is present. […] Penicillin is the only drug that has proved effective in the treatment of neurosyphilis. […] The CDC endorses two regimens. The first is aqueous crystalline penicillin G, in a dosage of 3 to 4 million units administered intravenously every four hours for 10 to 14 days.

• #3 Syphilis Treatment & Management: Approach Considerations, Antibiotic Therapy, Surgical Care

  https://emedicine.medscape.com/article/229461-treatment

  A meta-analysis of randomized clinical trials comparing azithromycin to benzathine penicillin G for early syphilis was published in 2008 showing favorable results for azithromycin. […] Management of this reaction often involves symptomatic treatment (eg, with antipyretics and analgesics) and observation. […] Surgical care is reserved for treating the complications of tertiary syphilis (eg, aortic valve replacement). […] The primary goal of prevention is to limit the spread of syphilis. […] Empiric treatment with one dose of benzathine penicillin G 2.4 million units intramuscularly (IM) is recommended in all patients who have had sexual contact with a partner who has tested positive for primary, secondary, or early latent syphilis within the preceding 90 days. […] Monitor patients with syphilis to ensure adequacy of treatment. […] Patients with early syphilis should be monitored with repeat RPR or VDRL at 6- and 12-month intervals. […] Patients with latent syphilis should be monitored with RPR or VDRL at 6-, 12-, and 24-month intervals.

• #3 Syphilis: CDC Diagnosis and Treatment Guidelines – PcMED Project

  https://pcmedproject.com/id/syphilis-cdc-diagnosis-and-treatment-guidelines/

  For tertiary syphilis, treatment includes Benzathine penicillin G 7.2 million units administered as 3 weekly doses of 2.4 million units. […] For neurosyphilis, treatment includes Aqueous crystalline penicillin G, 3 to 4 million units IV every 4 hours for 10 to 14 days or penicillin G procaine, 2.4 million units IM daily plus probenicid 500 mg orally 4 times daily, for 10 to 14 days. […] Patients with penicillin allergy should be desensitized and treated with penicillin whenever possible. Doxycycline 100 mg BID x 14 days or tetracycline 500 mg 4 times daily for 14 days can be used for nonpregnant penicillin-allergic patients with primary or secondary syphilis. […] Nontreponemal titers decline after treatment and eventually become negative. Treponemal tests remain positive for life. Follow-up at 6, 12, 18 and 24 months after therapy should include serology. If symptoms persist or recur, or there is a >4 fold increase in nontreponemal test titer persisting more than 2 weeks, consider reinfection or treatment failure.

• #3 Syphilis | STI Guidelines Australia

  https://sti.guidelines.org.au/sexually-transmissible-infections/syphilis/

  Benzathine benzylpenicillin 2.4 MU (1.8 g) IMI, Stat, given as 2 injections containing 1.2 MU (0.9 g) […] Benzathine benzylpenicillin 2.4 MU (1.8 g) IMI, given as 2 injections containing 1.2 MU (0.9 g) weekly for 3 weeks. […] Intramuscular penicillin formulation used should be long acting, as short-acting formulations (e.g. benzylpenicillin) are ineffective. Benzathine benzylpenicillin is supplied as 1.2 MU pre-filled syringes. It is listed on the Pharmaceutical Benefits Scheme (PBS) general schedule and prescriber bag. Supply can be difficult to obtain, seek specialist advice if unable to obtain. […] Jarisch-Herxheimer reaction is a common reaction to treatment in patients with primary and secondary syphilis. It occurs 6-12 hours after commencing treatment, and is an unpleasant reaction of varying severity with fever, headache, malaise, rigors and joint pains, and lasts for several hours. Symptoms are controlled with analgesics and rest. Patients should be alerted to the possibility of this reaction and reassured accordingly.

• #3 Know the Most Effective, Fastest Syphilis Treatment for You

  https://clarewellclinics.co.uk/sti/syphilis/syphilis-treatment/

  Failure of treatment is uncommon, and is recognised by monitoring of Syphilis blood tests, and may warrant further courses of antibiotics. […] Most patients receive treatment of Syphilis without much problem and achieve a cure. […] Penicillin injections: pain at the injection site and allergic reactions. Oral antibiotics: nausea, sickness, abdominal pain, skin rash. […] The patients develop fever, headache, body pains and chill within 24 hours of starting the course of antibiotics, and often following the first dose. […] If their Syphilis test result is positive, they will be given treatment based on the stage of their Syphilis this will be determined at the time of the test. […] The effectiveness of Syphilis treatment is assessed by repeating the blood test at regular intervals, usually 3, 6 and 12 months after completion of treatment.

• #3 Open Search

  https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/syphilis/how-do-i-get-treated-for-syphilis

  Syphilis can be easily cured with antibiotics. Your sexual partners need to be treated, too. If you dont treat syphilis, it can lead to very serious health problems. […] Syphilis is usually super easy to get rid of in the early stages. Your nurse or doctor will prescribe antibiotics to treat the infection usually penicillin, unless youre allergic or cant take it for other reasons. […] If youre having syphilis treatment, its really important for your sexual partners to get treated also. Otherwise, you may pass the infection back and forth, or to other people. […] Take all of your medicine the way your doctor tells you to, even if your symptoms go away sooner. […] Your partner(s) should also get tested and treated for syphilis so you dont re-infect each other or anyone else. […] Dont have any kind of sex (vaginal, anal, oral) until you and your partners have finished your treatments, and any sores are totally healed.

• #3 Syphilis | STI Guidelines Australia

  https://sti.guidelines.org.au/sexually-transmissible-infections/syphilis/

  Advise no sexual contact for 7 days after treatment is commenced, or until the course is completed and symptoms resolved, whichever is later. […] Treat as for non-pregnant according to stage. Only penicillin has been shown to be effective, so those allergic should be desensitised and treated with penicillin. […] Non-penicillin regimens have less evidence than penicillin but have shown to be effective; seek specialist advice if considering alternative therapies. […] Early (< 2 years) syphilis: doxycycline 100 mg orally twice a day for 14 days [...] Late (> 2 years) or unknown duration syphilis: doxycycline 100 mg orally twice a day for 28 days.

• #3 The Critical Role of Penicillin in Syphilis Treatment and Emerging Resistance Challenges

  https://www.mdpi.com/2079-9721/13/2/41

  The Critical Role of Penicillin in Syphilis Treatment and Emerging Resistance Challenges […] Syphilis, a global healthcare burden, is a sexually transmitted infection caused by the spirochete Treponema pallidum, a spiral-shaped, Gram-negative obligate human pathogen. […] The first-line treatment, penicillin, faces challenges, including logistical issues, shortages, allergic reactions, and patient non-compliance. […] Syphilis is curable if it is treated properly after the initial exposure of chancre on the genitals or mouth by giving antibiotic BPG intramuscularly, which is also the case for secondary and early latent phase (2.4 million units if no treatment has been started) and aqueous penicillin G, as 18–24 million units every day intravenously for 10 to 14 days is the recommended treatment for neurosyphilis according to the WHO guidelines for the treatment of syphilis. […] Despite being treatable with penicillin, syphilis continues to be a global health concern with a significantly increasing number of cases. […] Penicillin has been recommended as a first-line antibiotic for syphilis treatment for many years and continues to be an effective treatment for T. pallidum infection. […] According to the WHO, approximately 10–20% of people with syphilis refuse intramuscular injections, and healthcare providers are often adverse to applying them, due to the increased operational and personnel costs involved with them. […] Second-line antibiotics such as doxycycline, ceftriaxone, and, in some special circumstances, azithromycin and erythromycin have been recommended to treat early syphilitic patients who are allergic and sensitive towards penicillin. […] The WHO guidelines for syphilis treatment point to the need for developing new treatments capable of combating T. pallidum infection broadly in the cases of early, late, and congenital syphilis. […] The continued reliance on penicillin as the first-line treatment for syphilis is a factor of its historical significance and clinical success over the decades. […] However, as syphilis resurges globally, particularly in specific high-risk populations, the limitations of penicillin as a sole therapeutic agent are becoming more apparent. […] Among the challenges presented by the continuous usage of penicillin are penicillin allergies, patient rejection due to a need for intramuscular injection, and supply-line troubles, limiting access to penicillin. […] Though T. pallidum has remained susceptible to penicillin for decades, recent reports of potential resistance, although rare, raise concerns about the future of this treatment. […] These issues suggest that we may be approaching a time where reliance on a single antibiotic regimen, even one as historically successful as penicillin, may not be sufficient. […] Future research must focus on identifying new therapeutic options, enhancing treatment adherence, developing new diagnostic and prophylactic tools, and developing public health programs that target at-risk populations more effectively.

• #3 Healthcare Providers – Syphilis

  https://www.vdh.virginia.gov/syphilis/healthcare-providers/

  Consider prescribing Doxycycline as post-exposure prophylaxis (DoxyPEP) for syphilis for patients who are clinically indicated. […] Report syphilis diagnoses to your local health department as soon as possible. […] Inform your patients diagnosed with syphilis that the health department will contact them to offer follow-up counseling and confidential partner services. […] It is important that all partners of patients diagnosed with syphilis are also tested and treated to prevent reinfections and further transmission.

• #3

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=uh3138

  Antibiotics can cure syphilis and prevent more serious problems caused by it. You and your sex partner or partners need antibiotic treatment. This is to prevent passing the infection back and forth or to others. […] If your doctor prescribed antibiotic pills, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics. […] Go to all follow-up tests. This helps your doctor check that treatment worked. Your doctor will tell you when to have testing done.

• #3 Syphilis | Better Health Channel

  https://www.betterhealth.vic.gov.au/syphilis

  Syphilis is curable but, if left untreated, can lead to serious complications. […] Early treatment of syphilis is effective. […] Penicillin is a very effective treatment for all stages of syphilis (including congenital syphilis). […] Other treatments are available if you are allergic to penicillin. Or you may be able to undergo a desensitisation procedure that safely allows you to be given penicillin. Early treatment helps to prevent further complications and to avoid passing the infection on to sexual partners or to an unborn baby during pregnancy. […] Although the treatment is straightforward, it is important to repeat blood tests to check that the treatment has worked.

• #4 Syphilis guide: Treatment and follow-up – Canada.ca

  https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/canadian-guidelines/syphilis/treatment-follow-up.html

  T. pallidum is highly sensitive to penicillin and the bacteria are rendered non-infectious on average within 24 hours of treatment with long-acting (LA) benzathine penicillin G. Long-acting benzathine penicillin is required to adequately treat infectious syphilis and achieve detectable serum levels of penicillin for two (2) to four (4) weeks in non-pregnant adults. A longer course of treatment is required to cure infections of longer duration (late latent and/or tertiary syphilis). […] Short acting penicillin agents are not adequate to cure syphilis. Although treatment regimens containing daily IM procaine penicillin for 10 to 14 days are as effective as those containing benzathine penicillin G-LA, benzathine penicillin G-LA is preferred because less frequent dosing (weekly) usually results in better adherence.

• #5 Syphilis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534780/

  Penicillin is the preferred bacteriocidal antibiotic for all stages of syphilis. It is most effective when bacteria are quickly reproducing. Treponema spp divide only once every 30 hours, so longer-acting forms of the antibiotic are typically preferred (procaine and benzathine penicillin), except for neurosyphilis where aqueous formulations are recommended as they can attain higher CSF concentrations. […] Treatment of syphilis depends on the disease stage, as recommended by the CDC as follows: Primary, secondary, and early latent syphilis are treated with a single dose of intramuscular (IM) benzathine penicillin G 2.4 million units. Tertiary, late latent syphilis, and HIV-infected patients with the disease should be treated with 2.4 million units of benzathine penicillin G IM weekly for 3 weeks. Neurosyphilis, including ocular disease and otosyphilis, should be treated with IV aqueous crystalline penicillin G 18 million to 24 million units (as a continuous IV infusion or 3 to 4 million units IV every 4 hours) daily for 10 to 14 days.

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