Syphilis - tertiary
Alternative names:
late syphilis; tertiary syphilis
Treatment:
The treatment of syphilis is determined by the length of time the person has been infected. Primary, secondary and latent syphilis of less than one year duration is treated as follows: - Benzathine penicillin 2.4 million units injected into a muscle (IM) as a single dose
- doxycycline 100 mg by mouth twice per day for 15 days
- tetracycline 500 mg by mouth four times per day for 15 days
- erythromycin 500 mg by mouth four times per day for 2 weeks
- ceftriaxone 250 mg IM daily for 10 days
For treatment of syphilis of greater than one year duration : - Benzathine penicillin 2.4 million units IM weekly for 3 weeks
- doxycycline 100 mg by mouth twice per day for 30 days
- tetracycline 500 mg by mouth twice per day for 30 days
Neurosyphilis: - aqueous penicillin G 12 to 24 million units injected into a vein (IV) daily for 10 days followed by benzathine penicillin 2.4 million units once a week for 3 weeks
- procaine penicillin 2.4 million units IM daily given with oral probenecid 500 mg four times per day--both for 10 days. This is followed by benzathine penicillin 2.4 million units once a week for 3 weeks.
Syphilis during pregnancy:
Penicillin is recommended as the only real drug of choice. Tetracycline can not be used because of toxicity to the fetus and erythromycin may fail to prevent congenital syphilis in the fetus. Penicillin allergic individuals should be desensitized and then treated with penicillin.
Several hours following treatment of early stages of syphilis individuals may undergo a febrile reaction called Jarish-Herxheimer reaction. Symptoms of this reaction include: These symptoms usually disappear within 24 hours.
Follow-up blood tests must be done at 3, 6, 12, and 24 months to ensure the infection has been eliminated. There must be abstinence from sexual conduct until 2 follow-up tests have indicated that the infection has been cured. Syphilis is extremely contagious in the primary and secondary stages.
Expectations (prognosis):
Late syphilis may be permanently disabling and may lead to death.
Complications:
Calling your health care provider:
The problems associated with tertiary syphilis are very significant and do not go unnoticed. Most individuals will automatically report to a physician if any of these symptoms appear. It is imperative that you inform your physician of the possibility of having had syphilis several to many years ago.
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