Treatment of Syphilis: Current Recommendations, Alternatives, and Continuing Problems

Abstract

Benzathine penicillin continues to be the cornerstone of recommended therapy for syphilis. Recent increases in the syphilis rates in the United States and concerns about the adequacy of currently recommended therapy for syphilis in patients with concomitant human immunodeficiency virus infection have stimulated reappraisal of alternatives to currently recommended therapy. Desirable features of antimicrobial agents for syphilotherapy include long serum half-life, good penetration into the central nervous system, and ease of administration. Benzathine penicillin provides prolonged treponemicidal levels of penicillin G in serum but does not reliably produce adequate levels of penicillin in the central nervous system. Tetracycline requires multiple daily dosing, has relatively frequent adverse effects, and has unproven efficacy for central nervous system involvement. Erythromycin, which may be less active than tetracycline for syphilis therapy, has similar shortcomings. Recent evaluations of ceftriaxone for early syphilis therapy are promising; however, the optimal dose and duration of therapy are unknown. No currently recommended therapy for syphilis is clearly optimal for reliable, cost-effective therapy. Careful reappraisal of currently available syphilotherapy and alternatives is needed.

Reducing stillbirths: prevention and management of medical disorders and infections during pregnancy

“…Prevalence is generally lower in high-income countries than in low-/middle-income countries. In 1990, the incidence of primary and secondary syphilis in the United States was 20 per 100,000 population, far less than the disease burden of 360 per 100,000 estimated for parts of Africa [ 119 , 120 ]. Syphilis remains a major cause of avoidable perinatal death in many low-/middle-income countries despite being treatable, and despite the WHO recommendation that all pregnant women be tested as part of routine ANC.…”

Treponematosis and Lyme borreliosis connections: Explanation for Tchefuncte disease syndromes?

“…The concentrated research efforts of the scientific community towards finding a vaccine for Lyme disease might also result in a vaccine for syphilis. With the possible exception of pinta, there has been a resurgence of all forms of treponematosis in world populations in recent years (Hook, 1989;Grimpel et al, 1991). Although penicillin remains an effective deterrent to the disease after it has become established in an individual, no preventative vaccine exists (Zenker and Rolfs, 1990).…”