- Syphilis
- Serologic Testing
- Early (primary,
secondary, or latent {< one-year})
- Primary
treatment:
- penicillin G benzathine
--(single dose)
- Alternative treatment:
- doxycycline (Vibramycin,
Doryx) -- multiple dose,
14 day duration
- Late (> one-year
duration, cardiovascular, gumma,
late-latent)
- Primary treatment:
- penicillin G benzathine
--(multiple dosing, 3
weeks)
- Alternative treatment:
- doxycycline (Vibramycin,
Doryx) -- (multiple
dosing, 4 weeks)
- Neurosyphilis
- Primary
treatment:
- penicillin G --(multiple
dosing, 10-14 days)
- Alternative treatment:
- penicillin G procaine--
(IM daily + probenecid
(Benemid): 10-14 days)
- Penicillin-allergic
patients-should be the sensitized
- Congenital
- Primary
treatment:
- Penicillin G or
- Penicillin G procaine
- Newborn
-- positive serological syphilis
test without stigmata of
syphilis:
- passive transfer of
maternal antibodies
- prenatal infection
- Treat seroreactive
infants immediately
rather than waiting to
determine if antibody
titer falls (3-6 months).
- Syphilis in pregnancy:
- penicillin G
- No need to re-treat
in subsequent pregnancy unless
clinical or serological evidence
of active/persistent infection
- Pregnant
women with penicillin allergy:
- hospitalization
- desensitization
- Syphilis & AIDS
- standard
penicillin treatments recommended
(with normal CSF)
- For some
patients: higher doses,
longer treatment required
- In some cases,
high-dose IV treatment may not
cure symptomatic neurosyphilis in
HIV patients
Reference:"Drugs
for Sexually Transmitted Infections", The
Medical Letter, vol. 41 (issue 1063), September,
24, 1999, Published by the Medical Letter, Inc,
New Rochelle, N.Y. |
Penicillin Review
- Bacteriocidal for
sensitive strains
- Inhibits cell wall
synthesis
- Primarily affects
gram-positive microbes
- Relatively non-toxic
- For both penicillins and
cephalosporins, bacteriocidal properties
require that bacterial cells are actively
growing and synthesizing cell walls.
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