Syphilis | Treatment and Prevention

Syphilis is a sexually transmitted disease, one transmitted by Treponema pallidum through abraded skin during sexual intercourse, or through the placenta in the pregnant female, causing congenital syphilis.

Syphilis treatment depends on the stage of the disease. These stages are:

1-Primary stage: The patient reports or shows a painless ulcer at the genital system (penis in males, vagina in females). This ulcer is called a chancre.
As mentioned before, Treponema pallidum is transmitted through abraded skin, not intact skin. Therefore, other types of sexual act, including homosexuals may also have chancres in the anus, and some display oral lesions due to oral sex.
This stage is easily treated and may heal spontaneously.

2-Secondary stage: The organism spreads through the blood to most organs.
The patient in this stage typically has a rash in the palms, soles and trunk, lymphadenopathy and mucocutaneous lesions.
This stage is easily treated, and if not, it may get worse.

3-Latent stage: In this stage, there is a lack of clinical manifestations, but the organism is still alive.
It divides into:

    • Early latent: The infection has less than one year,
    • Late latent: The infection has more than one year.

4-Tertiary (late) stage : In this stage, the disease affects the functions of organs, and the presentation depends on the organ affected.
It can affect the brain, nerves, eyes or heart.

Neurosyphilis and ocular syphilis: can occur at any stage, and the treatment should start as early as possible to avoid severe complications such as blindness and paralysis. CSF testing is required to detect neurosyphilis in late stages, or in patients who have neurological manifestations.

Syphilis treatment

Penicillin is the drug of the choice to treat syphilis, CDC regimens of treatment differ according to the stage of the disease.

1. Primary, secondary and early latent syphilis (less than one year):

The CDC recommends “benzathine penicillin G” single dose intramuscular (2.4 million units).

In the case of penicillin allergy, CDC recommends “doxycycline” twice daily orally (100 mg) for 14 days or “ceftriaxone” once daily intramuscular (1g ) for 10-14 days.