Adult
Syphilis
- Bacterial infection due to Treponema pallidum subspecies pallidum
- Transmission is by direct contact with infected lesions – sexually transmitted and mother to child transmission
- UK Cases are predominantly GBMSM; HIV coinfection is common
- Notifiable infection
Steroids are indicated for cardiovascular and neurological syphilis – this should be commenced 24 hours BEFORE antibiotics are started
Potentially incubating syphilis (contacts)
Includes HIV coinfected individuals
Preferred: Benzathine penicillin G 2.4 MU IM once only
Alternative: Doxycyline 100mg po bd 14 days
Early syphilis: primary, secondary and early latent
Includes HIV coinfected individuals
Preferred:
Benzathine penicillin G 2.4 MU IM once only
Alternatives:
- Procaine penicillin 600,000 units IM od for 10 days
- Or Doxycycline 100mg po bd 14 days
- Or Ceftriaxone 500mg-1g IM or IV od for 10 days
- Or, Amoxicillin 500mg po qds + probenecid 500mg po qds for 14 days
Late latent, Cardiovascular, or Gummatous Syphilis
Includes HIV coinfected individuals
Preferred:
Benzathine penicillin G 2.4 MU IM once weekly for 3 weeks
Alternatives:
- Doxycycline 100mg po bd 28 days
- Or, Amoxicillin 2g po tds (or 1.5g qds) + probenecid 500mg po qds for 28 days
- Or Ceftriaxone 2g IM or IV od for 10-14 days
PLUS (for cardiovascular) Prednisolone 40-60mg po od for 3 days, starting 24h before antibiotics
Neurosyphilis including neurological involvement in early syphilis (optic, ontological)
Includes HIV coinfected individuals
** Prednisolone 40-60mg po od for 3 days, starting 24h before antibiotics
Preferred:
- Procaine penicillin 1.8-2.4 MU IM od + probenecid 500mg po qds for 14 days
- Or, Benzylpenicillin 1.8-2.4 g IV every 4 hours for 14 days
Alternatives:
- Ceftriaxone 2g IM or IV once daily for 10-14 days
- Or, Doxycycline 200mg po bd 28 days
- Or, Amoxicillin 2g po tds (or 1.5g po qds) + probenecid 500mg po qds for 28 days