Syphilis treatment: old and new

Abstract

Syphilis has challenged scientists and clinicians since its first appearance in the late 1400s and debate continues to surround the best practice in management. Difficulties in defining the goals of successful treatment have contributed to problems in determining recommendations for the ideal management. Treatment regimens currently in use were developed before randomised controlled trials became standard. This, combined with national differences in disease definition, staging and varying interpretations of the studies, as well as the emergence of complicating comorbid conditions, such as HIV, has resulted in a lack of consensus for treatment. This paper will discuss the history and current treatment of syphilis focusing on dilemmas faced by clinicians today, including the emergence of a resistant strain. Despite the difference between current national guidelines, penicillin G largely remains the treatment of choice. Close follow up, monitoring and ensuring adequate compliance remain the most important aspects in the treatment of syphilis.

Ocular manifestations of syphilis: recent cases over a 2.5-year period

“…[37,38] American and European recommendations for treatment [39,40] suggest one 2.4-MUI intramuscular dose of penicillin G benzathine as the first-line therapy or an oral course of doxycycline 200 mg daily for 15 days in the case of penicillin allergy. However, ophthalmologic lesions of syphilis can occur at the latest stages of the disease and aqueous penicillin G dosing, 18-24 MUI daily for 3 weeks, seems to be more suitable [14,41,42]. A 10-day course of aqueous penicillin G seems to decrease the incidence of recurrence [30].…”

Neurology and Don Quixote

“…Many patients who underwent mercury treatments suffered from extensive tooth loss, ulcerations, and neurological damage (including epileptic seizures and tremors, such as the excerpt above). The use of mercury therapy continued until the first effective treatment, Salvarsan, was developed in 1910 by the immunologist Paul Ehrlich (1854–1915) [16]. …”

Syphilis, psychiatry and offending behaviour: clinical cases from nineteenth-century Ireland

“…Despite considerable advances in diagnostic techniques, for example, definitive diagnosis can still be challenging, especially in individuals with suspected neurosyphilis [4]. Treatment can also prove challenging, especially in relation to clinical follow-up, monitoring and co-ordination of national guidelines between countries [5]. Whilst antibiotics have assisted greatly with treatment of syphilis (and prevention of progression to tertiary syphilis) throughout the twentieth century, there are now reports of both treatment failures and genetic mutation of T. pallidum resulting in antibiotic resistance [38].…”

“…The protean clinical syndromes associated with syphilis have lengthy, complex histories in both medicine and psychiatry [1][2][3][4][5][6]. In the nineteenth century, syphilis in general, and neurosyphilis in particular, presented substantial challenges to medical and psychiatric services in many countries, including Ireland.…”