Treatment Recommendations for Syphilis in Non-Pregnant Adults by Syphilis Stage
Incubating Infection, Primary, Secondary, Early Latent Syphilis:
• Benzathine penicillin G 2.4 million units as a single intramuscular injection
Alternatives Regimens (for nonpregnant patients with a documented penicillin allergy)
• Oral doxycycline 100mg twice daily for 14 days
• Oral tetracycline 500mg 4 times each day for 14 days
Late Latent or Latent Syphilis of Unknown Duration:
• Benzathine penicillin G 7.2 million units total, administered as 3 separate doses of 2.4 million units intramuscuarly, each at 1-week intervals
Alternative Regimens (for nonpregnant patients with a documented penicillin allergy)
• Oral doxycycline 100mg twice daily for 28 days
• Oral tetracycline 500mg 4 times daily for 28 days
Neurosyphilis or Ocular/Otic Syphilis
• Aqueous crystalline penicillin G 18-24 million units per day, administered as 3-4 million units intravenously every 4 hours, or by continuous infusion, for 10-14 days
Alternative Regimen
• Procaine penicillin G 2.4 million units intramuscularly once daily for 10-14 days
PLUS
• Probenecid 500mg orally 4 times daily for 10-14 days
Tertiary syphilis should be managed in consultation with an infectious disease specialist. Testing for HIV infection and CSF examination should be performed before therapy is initiated.
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