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Syphilis Possible therapeutic alternatives
Syphilis (early)
Less than one year. Primary: ulcer or chancre at site of infection. Secondary: rash, mucocutaneous lesions, adenopathy.
T. pallidum
Benzathine Penicillin G   2.4mu IM x 1 (if pregnant-repeat therapy after 1 week).


Ceftriaxone 1 gram IV/IM q24h x 10 - 14 days OR
Doxycycline 100mg twice daily for 2 weeks  OR
Azithromycin 2000mg x 1 OR
Tetracycline 500mg four times daily for 2 weeks
Syphilis (late, or greater than one year duration) Tertiary (late): cardiac, neurologic, ophthalmic, auditory or gummatous lesions. T. pallidum
Benzathine Penicillin G 2.4 million units IM weekly x 3 doses

Penicillin allergic patients

Doxycycline 100mg twice daily for 28 days
500mg orally four times daily for 28 days. 
Neurosyphilis T. pallidum
Penicillin G  3 to 4 million units q4h IV for 10-14 days or 
Procaine penicillin 2.4 million units IM qd, +  probenecid 500 mg PO qid x 10-14 days
Ampicillin 4 grams IVPB every 6 hours for 10 to 14 days. // Desensitize penicillin allergic patients.


Secondary Syphilis