Unlike the diagnosis, treatment is fairly straightforward. During the primary, secondary, and early latent phases of syphilis, a single injection of penicillin cures the disease. People who are allergic to penicillin (and not pregnant) may be given oral antibiotics (such as doxycycline, tetracycline, or erythromycin) for 2 weeks.
People who are diagnosed to be in the late latent stage of syphilis (and are not sure how long they have been in this stage) and those with tertiary syphilis will require 3 injections, each 1 week apart. Oral antibiotics (most likely, doxycycline or tetracycline) are usually given to people in this stage who are allergic to penicillin.
If syphilis has advanced to neurosyphilis (or brain involvement), treatment with IV penicillin every 4 hours for 10-14 days may be required. An alternative is penicillin injections (once per day) with oral probenecid (4 times a day) for 10-14 days.
A pregnant woman with syphilis must have penicillin, even if she is allergic to it. She must tell her doctor of this allergy to allow for desensitization procedures.
After treatment with penicillin, a Jarisch-Herxheimer reaction may occur 2-12 hours after treatment starts. This reaction is the result of the dying bacteria and may cause previous symptoms to transiently worsen. Alarming as it may be, this reaction usually ends within 24 hours. Bed rest, pain relievers (such as aspirin, acetaminophen, or ibuprofen), and liquids can help.
Medically Reviewed by a Doctor on 10/5/2015
Scott E Rudkin, MD, MBA, RDMS
Scott H Plantz, MD, FAAEM
Francisco Talavera, PharmD, PhD
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