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For early latent syphilis (patients who acquired syphilis within the preceding year), benzathine penicillin G 2.4 million units IM in a single dose is recommended. Patients who have latent syphilis of unknown duration should be treated as having late latent syphilis. Treatment for late latent syphilis is benzathine penicillin G 7.2 million units total, given intramuscularly as three doses of 2.4 million units each at 1 -week intervals.


Penicillin Allergy

In cases of penicillin allergy, non-pregnant patients with early latent syphilis can be treated with the same alternative regimens as those with primary and secondary syphilis. In cases of late latent syphilis or latent syphilis of unknown duration, acceptable regimens include doxycycline (100 mg orally twice daily) or tetracycline (500 mg orally four times daily) for 28 days. However, outcomes using these regimens have not been well documented, requiring close clinical and serologic follow-up.


Assessing Response to Therapy

Quantitative nontreponemal serologic tests should be repeated at 6, 12, and 24 months following treatment of latent syphilis. Retreatment for latent syphilis (with normal CSF examination) is indicated if (1) titers increase fourfold, (2) an initial high titer (>1:32) does not decline fourfold within 12 to 24 months of therapy, or (3) signs or symptoms of active syphilis develop.


Men's Health