Sexually Transmitted Diseases--Drug Treatment
  • 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:
        1.  hospitalization
        2.  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.