Treatment of Syphilis, 1993

Abstract

Data on treatment of patients with syphilis were reviewed in preparation for revision of the Sexually Transmitted Disease Treatment Guidelines of the Centers for Disease Control and Prevention. Published studies of treatment regimens available and practical for use today were reviewed, particularly in regard to the following issues: treatment for primary, secondary, and latent stages of syphilis; treatment for syphilis during pregnancy; treatment for syphilis in human immunodeficiency virus (HIV)-infected patients; and serological criteria for evaluating response to treatment. The results of treatment and the methodological quality of the studies was considered. Most treatment recommendations must be based on expert judgment and with reliance on the clinical experience over 4 decades. For the treatment of early syphilis in HIV-uninfected patients, this is probably sufficient. Data about HIV-infected patients are insufficient both for determining whether current therapy is adequate and for recommendation of an alternative if a change in therapy is deemed necessary.

2014 European guideline on the management of syphilis

“…Uwagi ogólne [63][64][65][66][67][68][69] • Należy dążyć do osiągnięcia krętkobójczego stę-żenia penicyliny w surowicy, a w przypadku kiły OUN -także w PMR. Za krętkobójcze uznaje się stężenie powyżej 0,018 mg/l, ale jest to wartość znacznie niższa niż maksymalne skuteczne stęże-nie in vitro (0,36 mg/l).…”

IUSTI: 2008 European Guidelines on the Management of Syphilis

“…PCR, histological or immunofluorescent examination of a biopsy from a clinically suspected lesion and direct darkfield microscopy or PCR of the exudates of early syphilitic lesions for spirochaetes; † The evidence that HIV-infected patients with early syphilis may have an increased risk of (early) asymptomatic neurological involvement and higher rate of treatment failure with Benzathine penicillin compared with non-HIV-infected patients was confined to case reports, 42,49,52 but recent evidence suggests that that risk may be increased, although the evidence is still not conclusive. Careful follow-up for the development of symptomatic neurosyphilis is essential: 7,43,92 † Some specialists recommend CSF examination as part of the assessment of HIV-infected patients with late latent syphilis or latent syphilis of unknown duration (see 'General remarks' in 'Management'); † HIV-infection may be a risk factor for symptomatic early neurosyphilis, i.e., ocular and auricular syphilis and meningitis (see 'Case finding' and 'Management, general remarks': 21,82 B.…”

Congenital syphilis after treatment of maternal syphilis with a penicillin regimen exceeding CDC guidelines

“…7 The effectiveness of any treatment regimen is likely to be dependent on a number of variables, such as stage of maternal syphilis, the severity of fetal infection, timing of treatment, and fetal tissue penicillin levels. 4 Theoretically, severe fetal infection is most likely to occur with delayed treatment and during secondary maternal syphilis, when maternal spirochetemia is highest. More severe fetal infections are likely to cause more impairment of placental function, which might result in a reduction in fetal penicillin levels.…”