Coupon Accepted Successfully!


Treatment Guidelines for Syphilis Management

  1. Disease:
    1. Acquired syphilis
      1. Early
        Recommended regimens: primary, secondary, early latent, elapsing syphilis
        Benzathine penicillin g 2.4 million units im in a single dose (half in each buttock atd)
        Special considerations: (penicillin allergy): doxycycline (100 mg orally bd for 14 days)
      2. Late:
        Recommended regimens: 
        benzathine penicillin g 2.4 million units im .(half in each buttock atd), once a week for 3 weeks. If pt misses a weekly dose by more than 2 weeks restart the trt.
        Special considerations: penicillin allergy
  2. Doxycycline (100 MG ORALLY BD FOR 30 DAYS)
    1. Neuro syphilis:
      Recommended regimens: inj aq crystalline penicillin g 2 mu 4 hrly iv –14 days
      Special considerations: penicillin allergy doxycycline (100 mg orally twice daily for 30 days)
    2. Cardiovascular syphilis:
      Recommended regimens: aq procaine penicillin g 1.2 mu im daily-20 days (add 15 mg prednisolone po abf daily 2 d prior –3 days after)
    3. Congenital syphilis:
      Recommended regimens: inj crystalline penicillin g 50,000 u/kg iv daily –10 days.
      Special considerations: penicillin allergy: erythromycin 7.5-12.5 mg/kg /d po qid—30 days.
    4. Syphilis in pregnancy
      Recommended regimens: benzathine penicillin g acc. To stage.
      1. Late pregnancy- add 15 mg prednisolone po abf daily 2 d prior –3 days after trt. Educate the pt regarding signs of foetal distress.
      2. Pregnant patients who are allergic to penicillin
      3. Desensitization followed by benzathine penicillin g
  3. Cord Blood Positive Baby:
    1. Check VDRL (quantitative) on baby and mother, FTA IgM on baby
    2. Clinically obvious: treat as congenital syphilis
    3. Clinically uncertain: FU clinically and serologically for 3-6 months, treat if clinical features appear or if:
      1. persistent high titre
      2. rising titre
      3. infant's VDRL titre is higher than maternal level
    4. In situation where the mother and baby could not be followed-up, a single dose of benzathine penicillin 50,000 units/kg IMI should be given to the infant.
  4. Precautions In Treatment
    1. Risk of anaphylaxis
    2. Jarisch-Herxheimer reaction
      1. This reaction usually occurs within 12 hours after the first dose of treatment. It is believed to be due to hypersensitivity reaction to killed treponeme and their liberated toxins.
      2. In early syphilis, this reaction is common but harmless.
      3. Patient usually has flu-like symptoms, feverishness, chills and malaise. However, patient should be warned beforehand and symptomatic treatment like paracetamol may be necessary.
      4. In late syphilis, this reaction is uncommon but dangerous, causing morbidity and even death. Steroid cover before treatment is therefore important.
Deceases producing Jarisch-Herxheimer reaction
a. Syphilis (Secondary > Primary> early latent)
b. Cat Scratch disease
c. Q fever
d. Borreliosis
i. Lyme disease
ii. Tick -borne relapsing fever
e. Brucellosis
f. Bartonellosis
g. Typhoid fever
  1. Follow-Up
    1. Early Syphilis
      Patient should be followed up clinically and serologically. VDRL is repeated 3-monthly x 6 months and 6-monthly x 18 months (totally 24 months) after treatment. If the test is negative two years after treatment, the patient could be discharged. Most of the cases become seronegative by six months. Syphilis > one year duration should be followed up clinically and serologically once a year.
    2. Neurosyphilis
      Lumbar puncture should be repeated six month & one year after treatment.
  2. Retreatment should be considered in the following situations:
    1. Clinical relapse or reinfection
    2. Sero-relapse: sustained fourfold increase in VDRL (e.g. increase from 1:8 to 1:32)
    3. Sero-resistance: initial high titre of VDRL (1:8 or greater) which fails to show fourfold decrease within a year
  3. Prognosis
    The prognosis of treated syphilis depends on the following factors:
    1. Stage of the disease
      The cure rate is over 95% if the disease has been adequately treated in primary, secondary and latent stage.
    2. Degree of tissue damage
      The prognosis in tertiary stage is variable. It depends on the degree of damage in cardiovascular and neurological systems.

Test Your Skills Now!
Take a Quiz now
Reviewer Name