Table 2 Recommended and alternative syphilis treatment regimens [130]
From: Resurgence of syphilis: focusing on emerging clinical strategies and preclinical models
| Â | Recommended regimen | Alternative regimen 1 | Alternative regimen 2 |
|---|---|---|---|
Primary and secondary syphilis | |||
 In nonpregnant adults, including adults with HIV | Benzathine penicillin G 2.4 million units IM in a single dose | Doxycycline, 100 mg orally twice a day for 14 days Tetracycline, 500 mg orally 4 times a day for 14 days | Ceftriaxone, 1 g daily, IM or IV, for 10–14 days |
 In pregnancy | Penicillin G benzathine, 2·4 million units in a single intramuscular dose | Those allergic to penicillin should be desensitized and treated with penicillin G |  |
 Among infants and children | Benzathine penicillin G 50,000 units/kg body weight IM, up to the adult dose of 2.4 million units in a single dose |  |  |
Early latent syphilis | |||
 In non-pregnant adults, including adults with HIV | Benzathine penicillin G 2.4 million units IM in a single dose |  |  |
 In pregnancy | Benzathine penicillin G 2.4 million units IM in a single dose | Those allergic to penicillin should be desensitized and treated with penicillin G |  |
Late latent syphilis | |||
 In non-pregnant adults, including adults with HIV | Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervals | Doxycycline, 100 mg orally twice a day for 28 days Tetracycline, 500 mg orally 4 times a day for 28 days | Ceftriaxone may be effective; but optimal dose and duration are unknown |
 In pregnancy | Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervals | Those allergic to penicillin should be desensitized and treated with penicillin G |  |
Tertiary syphilis | |||
 With gummas and cardiovascular manifestations but not neurosyphilis | Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervals |  |  |
Neurosyphilis, ocular syphilis, and otosyphilis | |||
 Including adults with HIV | Aqueous crystalline penicillin G 18–24 million units per day, administered as 3–4 million units IV every 4 h or continuous infusion for 10–14 days | Procaine penicillin G 2.4 million units IM once daily plus Probenecid 500 mg orally 4 times a day, both for 10–14 days | Benzathine penicillin, 2.4 million units IM once per week for 1–3 weeks, can be considered after completion of these neurosyphilis treatment regimens |
Congenital syphilis | |||
 Confirmed, highly probable, or possible congenital syphilis | Aqueous crystalline penicillin G 100,000–150,000 units/kg/body weight/day, administered as 50,000 units/kg body weight/dose IV every 12 h during the first 7 days of life and every 8 h thereafter for a total of 10 days | Procaine penicillin G 50,000 units/kg body weight/dose IM in a single daily dose for 10 days | Benzathine penicillin G 50,000 units/kg body weight/dose IM in a single dose |
 Among infants and children | Aqueous crystalline penicillin G 200,000–300,000 units/kg body weight/day IV, administered as 50,000 units/kg body weight every 4–6 h for 10 days |  |  |
Management of sex partners | |||
 Persons who have had sexual contact with a person who receives a diagnosis of primary, secondary, or early latent syphilis < 90 days | Should be treated presumptively for early syphilis |  |  |
 Persons who have had sexual contact with a person who receives a diagnosis of primary, secondary, or early latent syphilis > 90 days | Should be treated presumptively for early syphilis or treated empirically |  |  |