Primary and secondary syphilis therapy

Primary and secondary syphilis therapy

TREATMENT

Primary and secondary syphilis therapy.

 

Benzathine penicillin G, 2.4 million units IM, single dose

 

Penicillin allergy

 

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

Penicillin allergy

 

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

Penicillin allergy

Ceftriaxone, 2 g IM or IV, qd x 10 to 14 days

Desensitize and treat with penicillin

Syphilis therapy in pregnancy

  1. Penicillin is the drug of choice. Therapy should be appropriate for the woman’s stage of syphilis.
  2. 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.

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