Treatment of syphilis

Abstract

THE RESULTS OF THE TREATMENT OF EARLY SYPHILIS WITH PENICILLIN HAVE BEEN EXCELLENT: patients are rendered non-infectious within hours, sero-reversal to tests with lipid antigens occurs within months and insignificant numbers of patients with cardiovascular or neurosyphilis are found among those who have received adequate treatment. On the other hand, seropositivity to tests with treponemal antigens may persist, sometimes indefinitely, and reinfections are, today, by no means uncommon. The physician also has a responsibility to persuade the patient with early infectious syphilis to induce the person who was the source of the infection and subsequent sexual partners to undergo examination and treatment.In late syphilis, no treatment can repair structural damage that has already occurred, e.g., severed neurons in the nervous system or loss of elastic tissue in the aortic wall, and clinical progression may occur in spite of treatment. Nevertheless, penicillin provides the basis of therapy.Early congenital syphilis, like the acquired infection, responds well to penicillin. However, because benzathine penicillin penetrates poorly into the cerebrospinal fluid much higher doses of procaine penicillin are now recommended, or alternatively the use of crystalline penicillin G.A recent WHO Scientific Group on Treponemal Infections has made new recommendations concerning the treatment of syphilis and these will be considered by the next WHO Expert Committee on Venereal Diseases, Treponematoses and Neisseria infections. Some of these recommendations are outlined in this article.