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Syphilis
What is Syphilis?
Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. Syphilis can cause serious health sequelae if not adequately treated.
Syphilis within the State of Georgia
In 2022, a total of 2182 cases of primary and secondary syphilis were reported in Georgia. However, when compared to other states in the U.S., Georgia ranked 20th in reported primary and secondary syphilis, displaying significant improvement from last year.
Additional Information and Facts
Testing and Treatment
Who should be tested for syphilis?
Any person with signs or symptoms suggestive of syphilis should be tested for syphilis. Also, anyone with an oral, anal, or vaginal sex partner who has been recently diagnosed with syphilis should be tested for syphilis. Some people should be tested (screened) for syphilis even if they do not have symptoms or know of a sex partner who has syphilis. Anyone sexually active should discuss his or her risk factors with a healthcare provider and ask whether he or she should be tested for syphilis or other STDs. In addition, providers should routinely test for syphilis in persons who
- are pregnant;
- are sexually active men who have sex with men (MSM);
- are living with HIV and are sexually active;
- are taking PrEP for HIV prevention.
What is the treatment for syphilis?
For detailed treatment recommendations, please refer to the 2021 CDC STD Treatment Guidelines. Penicillin G, administered parenterally, remains the preferred treatment for all stages of syphilis. The specific type of penicillin (benzathine, aqueous procaine, or aqueous crystalline), dosage, and treatment duration depend on the disease stage and clinical manifestations. Selection of the appropriate penicillin preparation is important because T. pallidum can reside in sequestered sites (e.g., the central nervous system (CNS) and aqueous humor) that are poorly accessed by certain forms of penicillin. Combinations of benzathine penicillin, procaine penicillin, and oral penicillin preparations are not considered appropriate for syphilis treatment. Bicillin L-A® is the first-line recommended treatment for syphilis and the only recommended treatment option for some patients. The FDA has listed penicillin G benzathine injectable suspension products (Bicillin L-A®) on their drug shortage webpage. For more information regarding clinical reminders during Bicillin L-A® shortage, refer to CDC guidance https://www.cdc.gov/sti/php/from-the-director/2023-07-20-mena-bicillin.html?CDC_AAref_Val=https://www.cdc.gov/std/dstdp/dcl/2023-july-20-Mena-BicillinLA.htm.
Primary and Secondary Syphilis
For primary and secondary syphilis, the CDC recommends a single dose of Benzathine penicillin G 2.4 million units intramuscularly (IM).
Latent Syphilis
In cases of latent syphilis, treatment varies based on the duration of infection. Early latent syphilis requires a single dose of Benzathine penicillin G 2.4 million units IM. For late latent syphilis or syphilis of unknown duration, a total of 7.2 million units of Benzathine penicillin should be administered as three doses of 2.4 million units each at one-week intervals.
Tertiary Syphilis
Tertiary syphilis, which can affect various organ systems, is treated with Benzathine penicillin G 2.4 million units IM weekly for three weeks. This longer duration of treatment is necessary due to the potential slow replication of the bacteria in these stages (CDC.gov).
Neurosyphilis, Ocular Syphilis, and Otosyphilis
Neurosyphilis and syphilis affecting the eyes or ears require more specific management. The recommended treatment is aqueous crystalline penicillin G 18-24 million daily units, administered as 3-4 million units IV every four hours for 10-14 days. (CDC.gov) (CDC.gov).
Special Considerations
For those allergic to penicillin, alternative treatments include doxycycline or tetracycline for non-pregnant patients. Multiple therapies might be effective for nonpregnant persons with penicillin allergy who have primary or secondary syphilis. Doxycycline (100 mg orally 2 times/day for 14 days) and tetracycline (500 mg orally 4 times/day for 14 days) have been used for years and can be effective. However, pregnant women should undergo desensitization and be treated with the recommended penicillin regimen for their stage of infection. Patients co-infected with HIV should receive the same treatment regimens as those without HIV but with careful monitoring due to potential differences in treatment response (CDC.gov) (CDC.gov).
For more detailed information, you can refer to the CDC guidelines on Primary and Secondary Syphilis, Latent Syphilis, Tertiary Syphilis, Neurosyphilis, Ocular Syphilis, and Otosyphilis and Syphilis During Pregnancy
Content source:
Centers for Disease Control and Prevention. (2021, July 22). Primary and secondary syphilis - STI treatment guidelines. https://www.cdc.gov/std/treatment-guidelines/p-and-s-syphilis.htm
Centers for Disease Control and Prevention. (2021, July 22). Latent syphilis - STI treatment guidelines. https://www.cdc.gov/std/treatment-guidelines/latent-syphilis.htm
Centers for Disease Control and Prevention. (2021, July 22). Tertiary syphilis - STI treatment guidelines. https://www.cdc.gov/std/treatment-guidelines/tertiary-syphilis.htm
Centers for Disease Control and Prevention. (2021, July 22). Neurosyphilis, ocular syphilis, and otosyphilis - STI treatment guidelines. https://www.cdc.gov/std/treatment-guidelines/neurosyphilis.htm
Page last updated 8/14/2024