Treatment of Syphilis in Non-Pregnant Individuals Allergic to Penicillin

Treatment Regimens by Stage

• The Centers for Disease Control and Prevention recommends doxycycline 100 mg orally twice daily for 14 days as the alternative treatment for primary and secondary syphilis in non-pregnant individuals allergic to penicillin 1, 2, 3
• For late latent syphilis or syphilis of unknown duration, the Centers for Disease Control and Prevention recommends doxycycline 100 mg orally twice daily for 28 days 2, 4

Important Considerations

• The Centers for Disease Control and Prevention prefers doxycycline over tetracycline due to better compliance with twice-daily dosing versus four-times-daily dosing 1, 3
• Close clinical and serological follow-up is essential for all patients treated with alternative regimens, according to the Centers for Disease Control and Prevention 1, 2

Follow-Up Recommendations

• The Centers for Disease Control and Prevention recommends quantitative nontreponemal serologic tests to be repeated at 6, 12, and 24 months after treatment 4, 7
• Re-treatment should be considered if titers increase fourfold, an initially high titer fails to decline at least fourfold within 12-24 months, or signs or symptoms attributable to syphilis develop, as recommended by the Centers for Disease Control and Prevention 4, 7

Special Situations

• For HIV-infected patients, the Centers for Disease Control and Prevention recommends the same doxycycline regimens, but with closer monitoring at 3-month intervals instead of 6-month intervals 4