Table 2.

Treatment of syphilis in non-HIV-infected personsa

StageTreatmenta in:
Patients not allergic to penicillinPatients allergic to penicillinc
Primary, secondary and early latent syphilis (<1 yr)Benzathine penicillin G, 2.4 mU i.m. in a single dose Children: Benzathine penicillin, 50,000 U/kg i.m., to a maximum of 2.4 mUDoxycycline,d 100 mg p.o. bid for 2 wk or Tetracycline, 500 mg p.o. qid for 2 wk or Erythromycin,e40mg/kg/day (max 500 mg/dose) p.o. in divided doses for 14 days or Ceftriaxone, 1 g daily for 8–10 days
Late latent (> 1 yr) or latent syphilis of unknown durationf Benzathine penicillin G, 7.2 mU i.m., given as three doses of 2.4 mU i.m. each at 1-wk intervalsDoxycycline,d 100 mg p.o. bid for 4 wk or Tetracycline, 500 mg p.o. qid for 4 wk
Children: Benzathine penicillin, 150,000 U/kg i.m., to a maximum of 7.2 mU, divided and given as three equal doses at 1-wk intervals
Late syphilisg (gumma or cardiovascular syphilis, not neuro ) Benzathine penicillin G, 7.2 mU i.m., given as three doses of 2.4 mU i.m. each, at 1-wk intervalsDoxycycline,d 100 mg p.o. bid for 4 wk or Tetracycline, 500 mg p.o. qid for 4 wk
Neurosyphilis, including syphilitic eye diseaseh Aqueous crystalline penicillin G, 18–24 mU daily, administered as 3–4 mU i.v. every 4 h for 10–14 days or Procaine penicillin, 2.4 mU i.m. daily,plus probenecid, 500 mg p.o. qid, both for 10–14 days
Congenital syphilisi
 <1 mo oldAqueous crystalline penicillin G, 100,000–150,000 U/kg/day, administered as 50,000 U/kg/dose i.v. every 12 h for the first 7 days of life and every 8 h thereafter for a total of 10 daysor Procaine penicillin, 50,000 U/kg/dose i.m. daily in a single dose for 10 days
 >1 mo oldAqueous crystalline penicillin G, 200,000–300,000 U/kg/day i.v., administered as 50,000 U/kg every 4-6 h for 10 days
  • a Adapted from references43 and 191 with permission of the publishers.

  • b i.m., intramuscular; mU, million units; p.o., orally; bid, twice daily; tid, thrice daily; qid, four times daily; i.v., intravenous.

  • c Penicillin-allergic pregnant patients and those with neurosyphilis should be treated with penicillin, after desensitization if necessary.

  • d There is less clinical experience with doxycycline than tetracycline, but compliance is likely to be better with doxycycline.

  • e If adequate compliance and follow-up can be assured. Note that this is less effective than other regimens.

  • f Tertiary disease should be excluded before treatment for latent syphilis is started.

  • g Patients with symptomatic late syphilis should undergo CSF examination before therapy. There is very little evidence to support the use of nonpenicillin regimens, and if these are to be used, a lumbar puncture should be carried out before therapy is begun.

  • h Many experts recommend treating patients with auditory syphilitic disease with the same regimens as for neurosyphilis, regardless of the findings on the CSF examination. Many experts recommend following intravenous therapy for neurosyphilis with i.m. benzathine penicillin, 2.4 mU weekly for 3 weeks.

  • i Asymptomatic infants with negative laboratory findings born to women treated with nonpenicillin regimens should receive benzathine penicillin, 50,000 U/kg i.m., as a single dose if follow-up is assured.