Treatment of asymptomatic congenital syphilis: Benzathine versus procaine penicillin G therapy

Syphilis

“…If the mother's treatment was inadequate, and an asymptomatic infant's nontreponemal test is reactive, the infant is deemed to have probable congenital syphilis [78]. This regimen has also been supported by two small clinical studies [421,422]. Single-dose benzathine penicillin therapy has been widely used in the past, and its use allows for earlier hospital discharge of the infant with subsequent improved maternal-infant interaction and decrease in hospitalization costs [420].…”

“…If medical follow-up is certain, the infant may be treated with a single intramuscular dose of benzathine penicillin G, 50,000 U/kg. If the infant is to receive a single intramuscular injection of benzathine penicillin G, a complete evaluation-including a lumbar puncture-is mandatory [78,279,390,421,422]. This regimen has also been supported by two small clinical studies [421,422].…”

“…Given the difficulty of ruling out neurosyphilis unequivocally, many experts prefer the 10-day intravenous course with aqueous crystalline penicillin G for all infants in this category [267,287,397]. Some experts recommend that a single dose of benzathine penicillin be administered as described previously [78,121,390,421,422]. If the meaning of a positive RPR result in an otherwise normal infant is in doubt, and the results of all other tests are negative, repeat quantitative RPR testing should be undertaken [78,390].…”

Syphilis. Leitlinie der Deutschen STD Gesellschaft zur Diagnostik und Therapie der Syphilis

“…Evidenzbasierte klinische Studien zur Behandlung der verschieden Stadien der Syphilis wurden in den letzten 10 Jahren in nur sehr geringem Umfang durchgeführt. Weltweit wurden lediglich 5 randomisierte und kontrollierte Studien veröffentlicht (Paryani 1994, Rolfs 1997, Serragui 1999, Hook 2002 (Norgard & Miller 1981, Stapleton et al 1985 spielten in den vergangenen 2 Jahrzehnten keine Rolle. Wegen der langen Generationszeit der Treponemen ist eine Mindestbehandlungsdauer von 10 Tagen erforderlich.…”

Congenital and perinatal infections

“…Figura 1 -Fluxograma de orientação para diagnóstico presuntivo de sífilis em recém-nascidos de mães com testes sorológicos positivos Apesar de ter sido e continuar sendo ampla e satisfatoriamente utilizada para tratamento de sífilis congêni-ta 29 , a penicilina benzatina em dose única pode não permitir que se atinjam níveis liquóricos treponemicidas por 10 dias. Há um relato de falha dessa modalidade terapêutica em duas crianças assintomáticas que não foram completamente avaliadas para descartar sífilis congênita e cujas mães tiveram sífilis recente 30 .…”