Syphilis Treatment Regimens Reviewed
the MPR take:
A study published in the Journal of the American Medical Association (JAMA) reviews the efficacy of multiple therapies for the treatment of syphilis, an increasing public health problem in the U.S. (approximately 55,000 new infections are expected in 2014). The authors included 11 randomized trials that provided evidence for various treatment strategies; these studies included 11,102 patients. For the treatment of early syphilis (primary, secondary, and early latent infection), the data supports the use of a single IM injection of benzathine penicillin G 2.4 million Units; this regimen provided 90–100% success rates. With early syphilis, serologic response should be seen by six months. A multi-dose regimen for early syphilis does not appear to have greater benefit over single-dose administration. For late and late latent syphilis, three weekly injections of benzathine penicillin G 2.4 million Units is recommended. Serologic response is generally slower with latent syphilis (12–24 months). When penicillin cannot be used, doxycycline and ceftriaxone are also effective against syphilis. Azithromycin, however, should not be used in the U.S. because of the potential for resistance. The authors conclude that penicillin will likely continue to be the drug of choice for treating syphilis. More research will need to be conducted to find appropriate regimens for HIV-infected patients and pregnant women, but the data that is available supports the use of first-line treatment with penicillin.
The incidence of syphilis in the United States is increasing; it is estimated that more than 55 000 new infections will occur in 2014. Treatment regimens are controversial, especially in specific populations, and assessing treatment response based on serology remains a challenge.