What Are the Treatment Options for Syphilis?

Syphilis is primarily transmitted through sexual activity and its onset is relatively rapid. It can lead to symptoms such as skin ulceration, rash, and fever, and in severe cases, it can even be fatal. Therefore, it is crucial for individuals with syphilis to seek timely medical attention.

For patients with early-stage syphilis (including primary, secondary, and early latent syphilis), penicillin therapy can be an effective treatment option. For patients who are sensitive to penicillin, injection of tetracycline hydrochloride or doxycycline may be recommended, followed by regular follow-up to monitor the progress of treatment.

I. Early Syphilis (including primary, secondary, and early latent syphilis)

1. Penicillin Therapy

(1) Benzathine penicillin G (long-acting penicillin) 2.4 million units, injected intramuscularly into both buttocks, once weekly for a total of 3-6 times.

(2) Procaine penicillin G 800,000 units per day, injected intramuscularly for a continuous period of 10-15 days, with a total dosage of 8-12 million units.

2. For patients allergic to penicillin

(1) Tetracycline hydrochloride 500mg, taken orally four times a day for 15 days.

(2) Doxycycline 100mg, taken orally twice a day for 15 days.

II. Tertiary Syphilis (including tertiary cutaneous, mucosal, and bone syphilis, late latent syphilis), and recurrent secondary syphilis.

1. Penicillin Therapy

(1) Benzathine penicillin G 2.4 million units, injected intramuscularly once weekly for a total of 3 times.

(2) Procaine penicillin G 800,000 units per day, injected intramuscularly for a continuous period of 20 days.

2. For patients allergic to penicillin

(1) Tetracycline hydrochloride 500mg, taken orally four times a day for 30 days.

(2) Doxycycline 100mg, taken orally twice a day for 30 days.

III. Syphilitic cardiovascular disease requires hospitalization. If heart failure is present, it should be treated first. Once the heart function has recovered, penicillin injection can be started at a low dosage, such as aqueous penicillin G. The initial dosage is 100,000 units once daily by intramuscular injection. The dosage is then increased to 100,000 units twice daily on the second day and 200,000 units twice daily on the third day. Starting from the fourth day, the following treatment protocol is followed (to avoid the Jarisch-Herxheimer reaction, prednisone 20mg/dose can be taken orally once daily for three consecutive days before starting penicillin injection).

1. Procaine penicillin G 800,000 units per day, injected intramuscularly for 15 consecutive days as one course of treatment. Two courses are required with a two-week break between them.

2. Tetracycline 500mg, taken orally four times a day for 30 days.

IV. Neurosyphilis requires hospitalization. To avoid the Jarisch-Herxheimer reaction during treatment, prednisone should be taken orally at a dosage of 20mg once daily for three consecutive days before starting penicillin injection.

1. Aqueous penicillin G is administered intravenously at a daily dosage of 12 million units (2 million units every four hours) for 14 consecutive days.

2. Procaine penicillin G is injected intramuscularly at a daily dosage of 1.2 million units, along with oral administration of probenecid at a dosage of 0.5g four times a day for 10-14 days. If necessary, benzathine penicillin G can be used at a dosage of 2.4 million units, injected intramuscularly once weekly for three consecutive weeks.