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Patient Management/Treatment
Syphilis in
Pregnancy
When syphilis is diagnosed in a pregnant woman, treat with penicillin according to stage of infection. Patients who are skin-test-reactive to penicillin should be
desensitized in the hospital and treated with penicillin.
Erythromycin is no longer an acceptable alternative drug for
penicillin-allergic patients. Some experts recommend that a second dose of Benzathine penicillin G 2.4 million units IM be administered 1 week after the initial dose for pregnant women who have primary, secondary, or early latent infection.
Treatment of the mother during the last month of pregnancy
or with a drug other than penicillin cannot be considered adequate treatment for the fetus.
Infants and
Children
Refer to the 2006 CDC STD Treatment Guidelines for information on the management of congenital and acquired syphilis in infants and children.
Jarisch-Herxheimer
Reaction
The Jarisch-Herxheimer reaction is a self-limited reaction to anti-treponemal therapy. It is characterized by fever, malaise, nausea, and vomiting. It may be associated with chills and exacerbation of secondary rash. This reaction occurs within 24 hours after therapy and usually resolves within 24 hours.
Patients should be warned that it is not an allergic reaction to penicillin and that it can be treated with symptomatic support. It occurs more frequently after treatment with penicillin and treatment of early syphilis, especially at the secondary stage. Pregnant women should be informed that treatment for syphilis may precipitate early labor and that they should notify an obstetrician if problems develop.
Syphilis and HIV/Other STDs
- HIV infected persons with early stage syphilis
should receive a single IM dose of 2.4mu of benzathine
penicillin
- Some specialists suggest that HIV-infected persons
with primary or secondary syphilis receive additional
treatments (e.g., benzathine penicillin G administered
at 1-week intervals for 3 weeks, as recommended for late
syphilis). However, the benefit of this approach remain
unproven.
- All patients who have syphilis should be tested for HIV infection.
- Persons with primary or secondary syphilis who live in areas with a high prevalence of HIV should be retested for HIV after 3 months if the first HIV test result was negative.
- Consider screening persons with syphilis for other STDs.
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