Warning:

This document is being maintained for historical purposes, but is now out of date. To view current guidelines please visit:

• STD Treatment Guidelines   at http://www.cdc.gov/STD/treatment

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1993 Sexually Transmitted Diseases Treatment Guidelines

09/24/1993

SUGGESTED CITATION
Centers for Disease Control and Prevention. 1993 Sexually
transmitted diseases treatment guidelines. MMWR 1993;42(No. RR-14):
{inclusive page numbers}.

CIO Responsible for this publication:
National Center for Prevention Services,
Division of Sexually Transmitted Diseases and HIV Prevention

Treatment -
     
     Parenteral penicillin G is the preferred drug for treatment of
all stages of syphilis. The preparation(s) used (i.e., benzathine,
aqueous procaine, or aqueous crystalline), the dosage, and the
length of treatment depend on the stage and clinical manifestations
of disease.

     The efficacy of penicillin for the treatment of syphilis was
well established through clinical experience before the value of
randomized controlled clinical trials was recognized. Therefore,
nearly all the recommendations for the treatment of syphilis are
based on expert opinion reinforced by case series, open clinical
trials, and 50 years of clinical experience.

     Parenteral penicillin G is the only therapy with documented
efficacy for neurosyphilis or for syphilis during pregnancy.
Patients with neurosyphilis and pregnant women with syphilis in any
stage who report penicillin allergy should almost always be treated
with penicillin, after desensitization, if necessary. Skin testing
for penicillin allergy may be useful for some patients and in some
settings (see Management of the Patient With a History of
Penicillin Allergy). However, minor determinants needed for
penicillin skin testing are not available commercially.

     The Jarisch-Herxheimer reaction is an acute febrile reaction -- 
accompanied by headache, myalgia, and other symptoms -- that may occur 
within the first 24 hours after any therapy for syphilis; patients should 
be advised of this possible adverse reaction. The Jarisch-Herxheimer 
reaction is common among patients with early syphilis. Antipyretics may 
be recommended, but there are no proven methods for preventing this 
reaction. The Jarisch-Herxheimer reaction may induce early labor or 
cause fetal distress among pregnant women. This concern should not 
prevent or delay therapy (see Syphilis During Pregnancy).

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