Syphilis is a sexually transmitted disease caused by a bacterium called Treponema pallidum. Its main symptom is a painless ulcer, like a cold sore in the genital region. If left untreated, the bacteria can spread throughout the body and, after years of infection, lead to serious complications such as impairment of the central nervous system.
Syphilis is curable, but you must treat it with appropriate antibiotics to get rid of Treponema pallidum. The treatment is set according to the stage of the disease.
In this article we will stick only to the treatment and cure of syphilis.
The antibiotic with better cure rates of syphilis is penicillin. The most widely used type of penicillin is benzathine penicillin, better known as Benzetacil.
Whenever possible, penicillin should be the first treatment option. Penicillin is so superior to other antibiotics, in some cases, even in patients allergic to penicillin, it remains the first choice. It is better to refer the patient to a desensitization process indicate another antibiotic.
Syphilis treatment regimen with penicillin
1) primary, secondary or early latent syphilis (less than one year of infection): most appropriate treatment: benzathine penicillin (Benzetacil) 2.4 million units in a single dose intramuscularly. Patients allergic to penicillin: doxycycline 100 mg 12 / 12 hours orally for 14 days.
2) Syphilis over 1 year, tertiary or indefinitely: most appropriate treatment: benzathine penicillin (Benzetacil) 2.4 million units in three intramuscular doses, one week interval between each. Patients allergic to penicillin: Doxycycline 100 mg of 12/12 hours orally for 28 days.
3) Neurosyphilis. Treatment:. Crystalline Penicillin G 3 to 4 million units every 4 hours intravenously for 10 to 14 days Patients allergic to penicillin desensitization treatment should be able to be treated with penicillin.
The positive HIV patient's treatment is exactly the same as the general population.
Treatment of syphilis in pregnancy
The treatment of syphilis in pregnancy is the same as the general population. In the case of pregnant allergic to penicillin, doxycycline is not an option as it is an antibiotic contraindicated during pregnancy. In these cases, the most suitable one is to perform allergy tests for allergy to penicillin can be demonstrated. Most patients who say allergic to penicillin actually are not. Some are no longer allergic over the years, while others have never been, just mistakenly interpreted any side effects with signs of allergy. If the tests the patient does not show serious signs of allergy to penicillin, the pregnant woman should go through a process of desensitization to penicillin so she can do the full course of Benzetacil.
After the end of treatment, the patient must repeat the examination VDRL every 6 months for 2 years. If the treatment has led to recovery of syphilis, the VDRL values fall at least 4 titers after the first 6 months, and continue to decline over the years.
Examples:
If the VDRL was 1/256 it should fall to 1/64.
If the VDRL was 1/128 it should fall to 1/32.
If the VDRL was 1/64 it should fall to 1/16.
The VDRL not need reaches zero to confirm the cure. Just the symptoms disappear and the VDRL fall materially. The values of the FTA-ABS not intended to be used in the therapeutic control.
About 15% of adequately treated patients do not show this decrease of 4 titles of VDRL. In these cases, the VDRL remains above 1/32, a new antibiotic course is indicated, and a serologic investigation of partner (s) (AS) is required. In patients with VDRL less than 1/32 and no symptoms, is not suggested repeat the treatment, except that titles VDRL to increase again.
If the patient has the right treatment and was cured of syphilis, there is no risk of the disease returning. However, it is important to note that have had syphilis does not generate immunity, which means that a person can become infected with Treponema pallidum more than once in life. So if you had syphilis, properly treated and cured, but returned to have sex with someone infected, there is a great risk of you again have syphilis again.
