Syphilis | Stages, Symptoms, Treatment & Prevention

Some advices should be put in consideration

Penicillin shouldn’t be taken orally or in combination, as the usage of two types of penicillin is absolutely contraindicated.

In patients who are diagnosed with HIV associated with syphilis, no additional drugs are needed, but the duration of therapy becomes longer and the follow-up is mandatory.

In the treatment of late syphilis, the interval between the doses is acceptable up to 14 days, but if the pregnant woman missed the dose, the course of treatment should be restarted again.

Benzathine penicillin is preferred to procaine penicillin in the treatment of syphilis in adults, and aqueous benzyl penicillin is preferred to procaine penicillin in the treatment of syphilis in infants.

Procaine has side effects, such as gastrointestinal tract upsets, but it’s well tolerated by the patient. Some patients complain of hallucinations and psychological changes, while others complain of fever and convulsions. These side effects are well tolerated and need no treatment. Only severe cases only may require treatment.

Doxycycline is preferred as a second line for treatment (not in the pregnant females) if desensitization is not available. Desensitization is a procedure that aims at decreasing penicillin allergy by administering small doses of penicillin in the hospital orally or intravenously for 4-12 hour. Thereafter, patients can respond well to penicillin treatment as penicillin is preferred as a first line for treatment.

Desensitization is important in the case of pregnancy, neurosyphilis, late syphilis, and congenital syphilis.

The goal of treatment is to eradicate Treponema pallidum and this effect is responsible for a type of reaction called Jarisch-Herxheimer reaction.

Jarisch-Herxheimer reaction is caused by releasing inflammatory mediators by the immune system as a response to the dying treponema pallidum organism. It occurs within 24 hours after receiving therapy. The patient displays a rash, fever, myalgia, headache and tachycardia. It doesn’t have a special treatment. The patient just needs supportive therapy as antipyretics and analgesics.

In pregnant females, this reaction can lead to early labor, but this side effect should be prevented at the initiation of therapy.