Syphilis

•  Serologic Testing

• Early (primary, secondary, or latent {< one-year})

  •  Primary treatment:

    •  Penicillin G benzathine --(single dose)

  •  Alternative treatment:

    •  Doxycycline (Vibramycin, Doryx) -- multiple dose, 14 day duration

• Late (> one-year duration, cardiovascular, gumma, late-latent)

  •  Primary treatment:

    •  Penicillin G benzathine --(multiple dosing, 3 weeks)

  •  Alternative treatment:

    •  Doxycycline (Vibramycin, Doryx) -- (multiple dosing, 4 weeks)

• Neurosyphilis

  •  Primary treatment:

    •  Penicillin G --(multiple dosing, 10-14 days)

  •  Alternative treatment:

    •  Penicillin G procaine-- (IM daily + probenecid (Benemid): 10-14 days)

  •  Penicillin-allergic patients-should be the sensitized

• Congenital

  •  Primary treatment:

    •  Penicillin G or

    •  Penicillin G procaine

  •  Newborn -- positive serological syphilis test without stigmata of syphilis:

    •  Passive transfer of maternal antibodies

    •  Prenatal infection

    •  Treat seroreactive infants immediately rather than waiting to determine if antibody titer falls (3-6 months).

• Syphilis in pregnancy:

  • Penicillin G

  • No need to re-treat in subsequent pregnancy unless clinical or serological evidence of active/persistent infection

  • Pregnant women with penicillin allergy:

    1.  Hospitalization

    2.  Desensitization

• Syphilis and AIDS

  • standard penicillin treatments recommended (with normal CSF)

    • For some patients: higher doses, longer treatment required

  •  In some cases, high-dose IV treatment may not cure symptomatic neurosyphilis in HIV patients.

   

 Reference: "Drugs for Sexually Transmitted Infections", The Medical Letter, vol. 41 (issue 1063), September, 24, 1999, Published by the Medical Letter, Inc, New Rochelle, N.Y.

• Penicillin Review

  • Bacteriocidal for sensitive strains

  • Inhibits cell wall synthesis

  • Primarily affects gram-positive microbes

  • Relatively non-toxic

  • For both penicillins and cephalosporins, bacteriocidal properties require that bacterial cells are actively growing and synthesizing cell walls.