Syphilis management for tertiary stage

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]Aysha Aslam, M.B.B.S[3]; Nate Michalak, B.A.

Overview

Tertiary syphilis refers to gumma and cardiovascular syphilis but not to all neurosyphilis. Patients who are not allergic to penicillin and have no evidence of neurosyphilis should be treated with Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervals.

Management for Tertiary Stage Syphilis

CDC Recommendations: Pharmacotherapy

Recommended Regimen

Other Management Considerations

Patients who have symptomatic late syphilis should be given a CSF examination before therapy is initiated. Patients with cardiovascular syphilis may be treated with the same regimen as neurosyphilis but there is limited data available to support this.[3]

Special Considerations

Penicillin Allergy: Alternative Regimen

  • Patients allergic to penicillin should consult with an infectious disease specialist to determine an effective regimen.

Pregnancy

Follow-Up

  • Limited information is available concerning clinical response and follow-up of patients who have tertiary syphilis.

References

  1. "Sexually Transmitted Diseases Treatment Guidelines, 2010". Retrieved 2012-12-19.
  2. http://www.cdc.gov/std/tg2015/syphilis.htm#Neurosyphilis Accessed on September 27, 2016
  3. Carrada-Bravo T (2006). "[Cardiovascular syphilis: diagnosis, treatment]". Arch Cardiol Mex. 76 Suppl 4: S189–96. PMID 17469346.

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