Syphilis

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Early Syphilis

Includes primary, secondary and latent syphilis of less than 2 years duration:

 

Medicine

Adult dose

Frequency

Duration

 

benzathine penicillin im

2.4MU (1.44g) 

one dose only

-

or

doxycycline po (in penicillin allergy)

100mg

twice a day

for 14 days           

or

erythromycin po

500mg

4 times a day

for 14 days           

Late Syphilis and syphilis during pregnancy

Includes latent syphilis of more than 2 years duration, latent neurosyphilis, gummatous, cardiovascular & neurosyphilis, and syphilis of unknown duration:

 

Medicine

Adult dose

Frequency

Duration

 

benzathine penicillin im

2.4MU (1.44g) 

Once a week

for 3 doses

or

doxycycline po (in penicillin allergy NOT pregnancy)

100mg

twice a day

for 30 days           

or

erythromycin po (in pregnancy)

500mg

4 times a day

for 30 days           
  • Pregnant women are now routinely tested for syphilis using a rapid diagnostic kit (TPHA equivalent). Pregnant women with syphilis require close surveillance especially, to identify re-infection after treatment. 
  • Partner Treatment: Note the importance of having sex partner treated, therefore always provide Contact Tracing Slip.
  • Babies born to women found to have syphilis during pregnancy should be treated even if the mother had been adequately treated during pregnancy:

Treatment for babies born to mothers with syphilis

Medicine

Paed dose

Frequency

benzathine penicillin im

30mg/kg [=50,000u/kg]

one dose only

Congenital Syphilis (babies clinically infected): ****

 

Medicine

Paed dose

Frequency

Duration

 

benzathine penicillin im

50,000u/kg [30mg/kg]

Once weekly

for 3 weeks

or

Procaine penicillin

50mg/kg [50,000u/kg]

Once a day

for 10 days           

or

erythromycin po (in penicillin allergy)

12.5mg/kg

4 times a day

for 10 days           

Neurosyphilis:

 

Medicine

Adult dose

Frequency

Duration

 

Benzylpenicillin iv

1.8-2.4g

Four hourly

2 weeks

or

benzathine penicillin im

2.4MU

Once weekly

3 weeks

or

Procaine penicillin im

600mg [=1ml in each buttock]

Once a day

21 days

or

doxycycline po 

200mg

twice a day

for 30 days           

or

erythromycin po (in penicillin allergic pregnant women)  

500mg

4 times a day

for 30 days           

and

Prednisolone po

40mg

Once daily

Three days starting 24 hours before other treatment