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This document is being maintained for historical purposes, but is now out of date.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

Late Syphilis
     
     Late (tertiary) syphilis refers to patients with gumma and
patients with cardiovascular syphilis, but not to neurosyphilis.
Nonallergic patients without evidence of neurosyphilis should be
treated with the following regimen.

Recommended Regimen -
     Benzathine penicillin G, 7.2 million units total, administered
     as 3 doses of 2.4 million units IM, at 1-week intervals.

Other Management Considerations
     Patients with symptomatic late syphilis should undergo CSF
examination before therapy. Some experts treat all patients who
have cardiovascular syphilis with a neurosyphilis regimen. The
complete management of patients with cardiovascular or gummatous
syphilis is beyond the scope of these guidelines. These patients
should be managed in consultation with experts.

Follow-Up
     There is minimal evidence regarding follow-up of patients
infected with late syphilis. Clinical response depends partly on
the nature of the lesions.

Management of Sex Partners
     Refer to General Principles, Management of Sex Partners.

Special Considerations

Penicillin Allergy -
     Patients allergic to penicillin should be treated according to
treatment regimens recommended for late latent syphilis.

Pregnancy -
     Pregnant patients who are allergic to penicillin should be
treated with penicillin, after desensitization, if necessary (see
Management of the Patient With a History of Penicillin Allergy and
Syphilis During Pregnancy).

HIV Infection -
     Refer to Syphilis Among HIV-Infected Patients.

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