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Benzathine penicillin G, 2.4 million units intramuscularly in a single dose, is recommended for both primary and secondary syphilis in adults.


Penicillin Allergy

For non-pregnant penicillin-allergic patients, either doxycycline (100 mg orally twice daily) or tetracycline (500 mg four times daily) for 14 days is considered an acceptable alternative. There are some data to support the use of azithromycin, as a single 1 or 2 g dose, as an acceptable alternative therapy for primary and secondary syphilis.


Assessing Response to Therapy

Following treatment, patients should be reevaluated clinically and serologically at 6 months and 12 months. Nontreponemal test titers should decline fourfold (two dilutions) at 1 year following treatment. Treatment failure is probable if nontreponemal titers do not decline fourfold by 6 months. These patients should be retested for HIV infection. Some specialists recommend CSF examination in the case of an inadequate serologic response, as treatment failure may be a result of unrecognized CNS infection. The recommended retreatment regimen is benzathine penicillin G 2.4 million units by weekly intramuscular injections for 3 weeks, unless neurosyphilis is present.


Men's Health