Syphilis management for primary and secondary stages
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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]
Overview
- Parenteral penicillin G has been used effectively for more than 50 years to achieve clinical resolution (i.e., the healing of lesions and prevention of sexual transmission) and to prevent late sequelae. However, no comparative trials have been adequately conducted to guide the selection of an optimal penicillin regimen (i.e., the dose, duration, and preparation). Substantially fewer data are available for non-penicillin regimens.
- Available data demonstrate that additional doses of benzathine penicillin G, amoxicillin, or other antibiotics in (primary, secondary, and early latent syphilis do not enhance efficacy, regardless of HIV status.
- Infants and children aged more than 1 month diagnosed with syphilis should have a CSF examination to detect asymptomatic neurosyphilis, and birth & maternal medical records should be reviewed to assess whether such children have congenital or acquired syphilis. Children with acquired primary or secondary syphilis should be evaluated (e.g., through consultation with child-protection services) and treated by using the following pediatric regimen.
CDC Recommendations: Pharmacotherapy [3]
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Recommended Regimen for Adults1. Benzathine penicillin G 2.4 million units IM in a single dose. Recommended Regimen for Infants and Children1. Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of 2.4 million units in a single dose. |
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Other Management Considerations
HIV-infection
- All persons who have syphilis should be tested for HIV infection.
- In geographic areas in which the prevalence of HIV is high, persons who have primary syphilis should be retested for HIV after 3 months if the first HIV test result was negative.
Neurosyphilis
- Patients who have syphilis and symptoms or signs suggesting neurologic disease (e.g., meningitis and hearing loss) or ophthalmic disease (e.g., uveitis, iritis, neuroretinitis, and optic neuritis) should have an evaluation that includes CSF analysis, ocular slit-lamp ophthalmologic examination, and otologic examination. Treatment should be guided by the results of this evaluation.
- Invasion of CSF by T. pallidum accompanied by CSF laboratory abnormalities is common among adults who have primary or secondary syphilis.[1] Therefore, in the absence of clinical neurologic findings, no evidence exists to support variation from the recommended treatment regimen for early syphilis.
- Symptomatic neurosyphilis develops in only a limited number of persons after treatment with the penicillin regimens recommended for primary and secondary syphilis. Therefore, unless clinical signs or symptoms of neurologic or ophthalmic involvement are present or treatment failure is documented, routine CSF analysis is not recommended for persons who have primary or secondary.
References
- ↑ Golden MR, Marra CM, Holmes KK (2003). "Update on syphilis: resurgence of an old problem". JAMA : the Journal of the American Medical Association. 290 (11): 1510–4. doi:10.1001/jama.290.11.1510. PMID 13129993. Retrieved 2012-02-16. Unknown parameter
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