Syphilis A Complete Treatment Guide

Syphilis is a sexually transmitted disease caused by bacterium  Treponema pallidum. It is known to have 4 Stages:

1) Primary

2) Secondary

3) Tertiary

4) Latent.

Signs and symptoms depend on the stage of Presentation. Primary syphilis present with Painless cancer(ulcers).

Secondary syphilis presents with a diffuse Rash Frequently over the hands and Soles. There may be sores in the mouth or vagina.

Latent syphilis may last many years with few or no symptoms at all.

Tertiary Syphilis has gammas(soft, non-cancerous growth), neurological, and heart symptoms.

In 2015, about 45.4 million people were infected with syphilis, with six million new cases. During

2015, it caused about 107,000 deaths, down from 202,000 in 1990. After decreasing dramatically with the availability of penicillin in the 1940s, rates of infection have increased since the turn of the millennium in many countries, often in combination with human immunodeficiency virus(HV) This is believed to be partly due to increased promiscuity, prostitution, decreasing use of condoms, and unsafe sexual practices among men who have sex with men.

Who can get Syphilis:

Anyone who is sexually active or was sexually active may have contracted syphilis or bloody discharge. Then you should get these treatments like syphilis treatment and bloody discharge treatment. Chances are higher in individuals with high-risk sexual behavior like multiple partners/ unprotected sex(no use of condoms)/ sex with commercial sex workers( Very High Risk)/Men having sex with Men etc

Syphilis  Treatment:

Early diagnosis and treatment are essential to prevent complications of syphilis.

Syphilis Treatment is mainly with antibiotics. There is no home remedy for syphilis treatment. A person should avoid intercourse until it is adequately treated.

It is important to check and treat all partners.

People having multiple sexual partners / unknown partners/ MSM/ lesbian partners should regularly check for Syphilis and other STDs.

Syphilis is easily treatable but the effects/damage is permanent. Hence it is prudent to diagnose and treat it early.

Prevention of syphilis probably is the best approach. Safe Sexual practices/ use of barrier methods like condoms/  regular check/ avoiding high-risk behaviors is advised.

Testing for Syphilis is easy and cheap. A simple blood test known as VDRL is used for screening of syphilis. If the test is positive then further testing can be done with blood best. Signs and symptoms along with a blood test report are used for the staging of disease.

Stage of disease decides the dose and duration of

Treatment, Syphilis treatment  is as follows:

Syphilis A Complete Treatment

Primary  and  Secondary  syphilis:

Parenteral penicillin G has been used effectively to achieve clinical resolution (i.e., the healing of lesions and prevention of sexual transmission) and to prevent late sequelae. However, no comparative trials have been conducted to guide the selection of an optimal penicillin regimen. Substantially fewer data are available for nonpenicillin regimens.

Recommended Regimen for Adults

Benzathine penicillin G 2.4 million units IM in a single dose.

Available data demonstrate that the use of additional doses of benzathine penicillin G, amoxicillin, or other antibiotics does not enhance efficacy when used to treat primary and secondary syphilis, regardless of HIV status.

 Recommended Regimen for Infants and Children

Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of 2.4 million units in a single dose


Clinical and serologic evaluation should be performed at 6 and 12 months after any kind of syphilis or veginal discharge treatment; more frequent evaluation might be prudent if follow-up is uncertain or if repeat infection is a concern. Serologic response (i.e., titer) should be compared with the titer at the time of treatment. However, assessing serologic response to treatment can be difficult, and definitive criteria for cure or failure have not been well established. In addition, nontreponemal test titers might decline more slowly for persons previously treated for syphilis.

Special Considerations

Penicillin Allergy

Data to support the use of alternatives to penicillin in the treatment of primary and secondary

syphilis are limited. However, several therapies might be effective in nonpregnant, penicillin-allergic persons who have primary or secondary syphilis.

Regimens of doxycycline 100 mg orally twice daily for 14 days and tetracycline (500 mg four times daily for 14 days) have been used for many years.

Limited clinical studies, along with biologic and pharmacologic evidence, suggest that ceftriaxone (1–2 g daily either IM or IV for 10–14 days) is effective for treating primary and secondary syphilis, the optimal dose and duration of ceftriaxone therapy have not been defined  Azithromycin as a single 2-g oral dose has been effective for treating primary and secondary syphilis in some populations.

 Latent  Syphilis

Because latent syphilis is not transmitted sexually, the objective of treating persons in this stage of the disease is to prevent complications and transmission from a pregnant woman to her fetus.

Although clinical experience supports the effectiveness of penicillin in achieving this goal, limited evidence is available to guide the choice of specific regimens or duration.

Recommended Regimens for Adults


Early  Latent  Syphilis

Benzathine penicillin G 2.4 million units IM in a single dose

Late  Latent  Syphilis  or  Latent  Syphilis  of  Unknown  Duration

Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM

each at 1-week intervals

Recommended Regimens for Infants and Children

Early  Latent  Syphilis

Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of 2.4 million units in a single dose

 Late  Latent  Syphilis

Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of 2.4 million units, administered as 3 doses at 1-week intervals (total 150,000 units/kg up to the adult total dose of 7.2 million units)


Quantitative nontreponemal serologic tests should be repeated at 6, 12, and 24 months.

Tertiary  Syphilis

Tertiary syphilis refers to gummas and cardiovascular syphilis but not to neurosyphilis. Persons who are not allergic to penicillin and have no evidence of neurosyphilis should be treated with the following regimen.

Recommended Regimen

Tertiary  Syphilis  with  Normal  CSF  Examination

Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM

each at 1-week intervals

To sum up, syphilis treatment is easy and simple. Readers should keep in mind the serious and permanent debilitating effect of syphilis. Syphilis can be prevented if you avoid high-risk sexual behavior, and can be easily diagnosed through regular checks.

If you are keen to test for syphilis or any STD’s or have any queries, want a confidential consultation on sexual matters/ STDs you can visit our doctors at MHC Medical center (Amara)

Written by:

Dr. Patil Anand Achyut

MBBS, GDOM Resident Physician

MHC Medical Centre(Amara)



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