Syphilis Treatment Guidelines

Treatment Recommendations

The Centers for Disease Control and Prevention recommends benzathine penicillin G 2.4 million units IM as a single dose for early syphilis, and 7.2 million units total as three doses of 2.4 million units IM at weekly intervals for late latent syphilis or syphilis of unknown duration 1, 2
For early latent syphilis, the American College of Physicians recommends benzathine penicillin G 2.4 million units IM as a single dose 1, 2
The Centers for Disease Control and Prevention recommends aqueous crystalline penicillin G 18-24 million units per day IV for 10-14 days for neurosyphilis 1, 2

The Infectious Diseases Society of America recommends doxycycline 100 mg orally twice daily for 14 days for early syphilis in non-pregnant patients with penicillin allergy 1, 2
The American College of Obstetricians and Gynecologists recommends penicillin desensitization followed by penicillin treatment for pregnant women with penicillin allergy 3, 2, 4

The Centers for Disease Control and Prevention recommends screening all pregnant women for syphilis at first prenatal visit, during third trimester, and at delivery 3, 4
The American College of Obstetricians and Gynecologists recommends using the same stage-appropriate penicillin regimens as non-pregnant patients for pregnant women 3, 4

The Infectious Diseases Society of America recommends repeat quantitative nontreponemal serologic tests at 6 and 12 months after treatment for early syphilis 2, 4
The Centers for Disease Control and Prevention recommends expecting a fourfold decline in titer within 6 months for early syphilis 2

The Centers for Disease Control and Prevention recommends presumptive treatment with benzathine penicillin G 2.4 million units IM for persons exposed within 90 days preceding diagnosis of primary, secondary, or early latent syphilis 2, 4

The Centers for Disease Control and Prevention recommends HIV testing for all patients with syphilis at the time of diagnosis 3, 2, 4
The American College of Physicians recommends informing patients about the possible adverse reaction of Jarisch-Herxheimer reaction, which may include headache, myalgia, fever, and other symptoms 2