The antibiotic penicillin is still the treatment of choice for syphilis. The administration, dosage and duration of therapy depend on the stage of the disease and the clinical symptoms of syphilis. The duration of therapy must be at least 2 weeks, or 3 weeks if infections of longer duration are suspected.
Sexual partners who have been exposed to an infection in the last 3 months should be treated independently of the serological result. Penicillin G is the treatment of choice during pregnancy. Patients who are allergic to penicillin should be desensitized and then treated.
A rare complication of syphilis therapy with penicillin G is the Jarisch-Herxheimer reaction. Due to the rapid massive pathogen decay under the influence of penicillin, large amounts of toxic bacterial components are released. This leads to fever up to 40 °C, headaches, muscle pain (myalgia), palpitations (tachycardia) and low blood pressure (hypotension).
The Jarisch-Herxheimer reaction subsides after 1-2 days and occurs in about 40-50% of treated pregnant women. After treatment for stage I or II syphilis, controls are performed 3, 6 and 12 months after the end of therapy using the VDLR and TPHA tests in conjunction with the detection of newly formed antibodies (IgM-AK). This is followed by annual controls over several years.
Quarterly controls are required for patients who belong to a risk group for sexually transmitted diseases. For stage III and IV syphilis, serum and CSF must be checked at semi-annual intervals for 3 years. For a successful therapy of syphilis, the unspecific antibodies against cardiolipin must drop to 0 within 6-12 months.
The specific ones remain present for life in terms of the serological scar. As an exposure prophylaxis, condoms offer protection against transmission. Symptomatic patients should not have sexual intercourse.
Since the pathogen is also very easily transmitted by smear infection from stage I and II lesions, gloves must be worn when physicians examine patients. There is no protective vaccination against T. pallidum. All pregnant women and all blood donors are tested for antibodies against T. pallidum.
For the prophylaxis of syphilis connata, careful pregnancy precautions are taken, including testing for antigen-antibody reactions. Syphilis or the direct or indirect detection of Treponema pallidum does not have to be reported by name in Germany (§ 7 IfSG).
