Therapy goals
- Elimination of the pathogens
- Avoidance of complications
- Partner management, i.e., infected partners, if any, must be located and treated (Primary infection: sexual partners of the last three months must be considered; Lues II: six months, Lues III: two years, Lues IV: up to 30 years).
- The S2k guideline requires notification of sexual partners of possible infection. In the presence of primary syphilis, this involves the partners of the last 3 months, in the case of secondary syphilis, those of the last 12 months.
Therapy recommendations
- Antibiosis (antibiotic therapy)
- Early syphilis: benzylpenicillins.
- Late syphilis: benzylpenicillins (penicillin G in neurosyphilis and connatal syphilis).
- Serological follow-up (quarterly for 12 months) should be performed after the end of therapy
- See also under “Further therapy“.
Antibiotics
Antibiotics are drugs that are administered when an infection with a bacterium is present. They act either bacteriostatic, by inhibiting the growth of bacteria, or bactericidal, which means that they kill the bacteria. Important representatives of this group of drugs are penicillin or cephalosporins. Penicillin is used for syphilis. Depending on the stage, the duration of therapy and the dose is changed. If penicillin is intolerant, doxycycline (2 × 100 mg/day for 14 days) may also be given.
Postexposure prophylaxis (PEP)
Postexposure prophylaxis is the provision of medication to prevent disease in persons who are not protected against a particular disease by vaccination but who have been exposed to it.
- Postexposure prophylaxis should be administered in the event of relevant pathogen contact.
- PEP consists of a single administration of benzathine benzylpenicillin (2.4 million IU, i. m. (same as therapy for early syphilis).
- Therapy requires patient education and consent.
Guideline
- WHO Guidelines for the Treatment of Treponema pallidum (syphilis). ISBN 978 92 4 154980 6 (NLM classification: WC 170) © World Health Organization 2016.
- S2k guideline: diagnosis and treatment of syphilis. (AWMF register number: 059-002), April 2020 long version.
- S1 guideline: neurosyphilis. (AWMF Register Number: 030 – 101), May 2020 Long version.
