Syphilis management for tertiary stage
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]Aysha Anwar, M.B.B.S[3]; Nate Michalak, B.A.
Overview
Tertiary syphilis refers to gumma and cardiovascular syphilis but not to all neurosyphilis. Patients who are not allergic to penicillin and have no evidence of neurosyphilis should be treated with Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervals.
Management for Tertiary Stage Syphilis
CDC Recommendations: Pharmacotherapy
Recommended Regimen
- Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervals.[1][2]
Other Management Considerations
Patients who have symptomatic late syphilis should be given a CSF examination before therapy is initiated. Patients with cardiovascular syphilis may be treated with the same regimen as neurosyphilis but there is limited data available to support this.[3]
Special Considerations
Penicillin Allergy: Alternative Regimen
- Patients allergic to penicillin should consult with an infectious disease specialist to determine an effective regimen.
Pregnancy
- Pregnant patients who are allergic to penicillin should be desensitized and treated with penicillin.
Follow-Up
- Limited information is available concerning clinical response and follow-up of patients who have tertiary syphilis.
References
- ↑ "Sexually Transmitted Diseases Treatment Guidelines, 2010". Retrieved 2012-12-19.
- ↑ http://www.cdc.gov/std/tg2015/syphilis.htm#Neurosyphilis Accessed on September 27, 2016
- ↑ Carrada-Bravo T (2006). "[Cardiovascular syphilis: diagnosis, treatment]". Arch Cardiol Mex. 76 Suppl 4: S189–96. PMID 17469346.