Primary and secondary syphilis therapy.
Benzathine penicillin G, 2.4 million units IM, single dose
Doxycycline, 100 mg, bid x 2 weeks, or
(2)Tetracycline, 500 m orally ,qid x 2 weeks
Latent and tertiary syphilis therapy.
Benzathine penicillin G, 2.4 million units IM, three doses at 1-week intervals
Doxycycline, 100 mg PO, bid x 4 weeks
Tetracycline, 500 mg PO, qid x 4 weeks
Alternate drugs: should only be used after cerebrospinal fluid (CSF) examination to rule out neurosyphilis
Neurosyphilis therapy. 2002 CDC guidelines
Aqueous crystalline penicillin G, 18 to 24 million units IV daily for 10 to 14 days
Procaine penicillin G, 2.4 million units IM daily, plus Probenicid, 500 mg, qid for 10 to 14 days
Ceftriaxone, 2 g IM or IV, qd x 10 to 14 days
Desensitize and treat with penicillin
Syphilis therapy in pregnancy
- Penicillin is the drug of choice. Therapy should be appropriate for the woman’s stage of syphilis.
- Penicillin allergy in pregnancy.
There are no alternatives to penicillin.
The patient should be desensitized and treated with penicillin.
Tetracycline and doxycycline are contraindicated during pregnancy.
Erythromycin does not effectively cross the placenta and cannot be relied on to cure an infected infant.