SYPHILIS. Gebre K. Tseggay, MD February 13, 2006. SYPHILIS INTRODUCTION. Caused by Treponema pallidum . Transmission: sexual; maternal-fetal, and rarely by other means.
February 13, 2006
~ 30% of secondary syphilis patients develop mucous patch (slightly raised, oval area covered by a grayish white membrane, with a pink base that does not bleed).
Positive syphilis serology without clinical signs of syphilis (& has normal CSF).
MHA-TP test (microhemagglutination assay for T. pallidum; agglutination of RBCs to which T. pallidum antigens have been fixed is the basis).
-Benzathine Penicillin G, 2.4 million units IM
-Doxycycline 100 mg twice daily x 14 days or
-Ceftriaxone 1 gm IM/IV daily x 8-10 days (limited studies) or
-Azithromycin 2 gm single oral dose (preliminary data)
*Use in HIV-infection has not been studied
*Azithromycin Rx Failures reported --- San Francisco, CA 2002--2003
Benzathine penicillin G 2.4 million units IM at one week intervals x 3 doses
Doxycycline 100 mg orally twice daily x 28 days or
Tetracycline 500 mg orally four times daily x 28d
*Note: Duration of therapy 28 days;
Close clinical and serologic follow-up;
Data to support alternatives to pcn are limited
Aqueous crystalline penicillin G, 18-24 million units administered 3-4 million units IV every 4 hours for 10-14 days
Procaine penicillin 2.4 million units IM daily plus probenecid 500 mg orally four times daily for 10-14 days
Some experts administer benzathine penicillin 2.4 million units IM wkly x 3 after completion of these regimens to provide comparable duration of treatment with latent syphilis
Primary and Secondary Syphilis
MMWR??? March 11, 2005 / 54(09);217-219
Sir William Osler
There was a young man from Back Bay
Who thought syphilis just went away.
He believed that a chancre
Was only a canker
That healed in a week and a day.
But now he has "acne vulgaris" -- (Or whatever they call it in Paris);
On his skin it has spread
From his feet to his head,
And his friends want to know where his hair is
There's more to his terrible plight:
His pupils won't close in the light
His heart is cavorting, His wife is aborting,
And he squints through his gun-barrel sight.
Arthralgia cuts into his slumber;
His aorta's in need of a plumber;
But now he has tabes,
And saber-shinned babies,
While of gummas he has quite a number.
He's been treated in every known way,
But his spirochetes grow day by day;
He's developed paresis,
Has long talks with Jesus,
And thinks he's the Queen of the May.
Aqueous crystalline penicillin G 100,000-150,000 units/kg/day, administered as 50,000 units/kg/dose IV q 12 hours during the first 7 days and thereafter q 8 hours for 10 days
Procaine penicillin G 50,000 units/kg/dose IM in a single daily dose for 10 days
Evaluation: CSF analysis, CBC/plt, long bone x-ray
Aqueous penicillin G 100,000-150,000 units/kg/day as 50,000 units/kg/dose IV every 12 hours for first 7 d then q 8 hours for total of 10 d
Procaine penicillin G 50,000 units/kg/dose IM in single daily dose for 10 d
Benzathine penicillin G 50,000 units/kg/dose IM in single dose
The course of untreated syphilis was studied
In the Oslo Study:
The Tuskegee Study showed that:
These two studies both showed that: