Treatment Regimens with Benzylpenicillins

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The Centers for Disease Control and Prevention recommends penicillin G benzathine 2.4 million units IM in a single dose for primary and secondary syphilis in adults 1
For early latent syphilis (less than 1 year duration), the recommended treatment is penicillin G benzathine 2.4 million units IM in a single dose for adults 1, 2
For late latent syphilis or latent syphilis of unknown duration, the recommended treatment is penicillin G benzathine 7.2 million units total, administered as three doses of 2.4 million units IM each at 1-week intervals for adults 1, 2
The American Academy of Pediatrics recommends penicillin G benzathine 50,000 units/kg IM up to the adult dose of 2.4 million units in a single dose for children with primary and secondary syphilis 1

The European Society of Clinical Microbiology and Infectious Diseases recommends penicillin G benzylpenicillin (or ampicillin) plus gentamicin as first-line treatment for early-onset sepsis (first 72 hours) 5
For early-onset sepsis, an alternative treatment is ampicillin plus gentamicin 5, 6

The Centers for Disease Control and Prevention recommends desensitization and treatment with penicillin for patients with penicillin allergy who require treatment for syphilis (especially pregnant women) 1, 2
For early syphilis in non-pregnant patients with penicillin allergy, the recommended treatment is doxycycline 100 mg orally twice a day for 14 days or tetracycline 500 mg four times a day for 14 days 8
Ceftriaxone 1 gram daily IM or IV for 8-10 days is an alternative treatment, although the optimal dose and duration are not well defined 8