Pharmacotherapy of Syphilis
Pharmacotherapy of Syphilis
Pharmacotherapy of Syphilis
The sores can also appear in the mouth or on the lips, tonsils, fingers or
buttocks. Most people only have one sore, but some people have more.
The sore will then disappear within two to six weeks. If the condition is
not treated, syphilis will move into its second stage.
Secondary syphilis
The symptoms of secondary syphilis will begin a few weeks after the
disappearance of the sore.
Symptoms can include:
a non-itchy skin rash appearing anywhere on the body, but commonly on the
palms of the hands or soles of the feet
small skin growths, often mistaken for genital warts – on women these
appear on the vulva and for both men and women they appear around the
anus
flu-like symptoms – such as tiredness, headaches, joint pains and fever
swollen lymph glands
weight loss
patchy hair loss
Latent syphilis can still be passed on during the first year of this
stage of the condition, usually through sexual or close physical
contact.
The latent stage can continue for many years (even decades) after
you first become infected.
The symptoms of tertiary syphilis will depend on what part of the body the infection
spreads to. For example, it may affect the brain, nerves, eyes, heart, bones, skin or
blood vessels, potentially causing any of the following symptoms:
stroke
dementia
loss of co-ordination
numbness
paralysis
blindness
deafness
heart disease
Skin rashes
During the latent stage of syphilis, skin lesions resolve, and patients are
asymptomatic. However, serologic tests are positive for T. pallidum.
Tertiary or late syphilis develops years after the initial infection and can
involve any organ system. The most dreaded complications are
neurosyphilis and involvement of the aortic valve and root.
PHARMACOTHERAPY
The goal of pharmacotherapy is to eradicate the causative
organism of syphilis, T pallidum.
Treatment will kill the syphilis bacterium and prevent further damage,
but it will not repair damage already done.
Syphilis Treatment and Care
Selection of the appropriate penicillin preparation is important to
properly treat and cure syphilis. Combinations of some penicillin
preparations (e.g., Bicillin C-R, a combination of benzathine
penicillin and procaine penicillin) are not appropriate
treatments for syphilis, as these combinations provide inadequate
doses of penicillin.
Penicillin G procaine
Penicillin G procaine is the first-line agent for treating late
latent syphilis.
Alternatives
Doxycycline
Doxycycline is used as alternative therapy for syphilis
infection.
Tetracycline
Tetracycline is used as alternative therapy for syphilis
infection. It inhibits bacterial growth by binding to the 30S
ribosomal unit, preventing protein synthesis.
Alternatives
Ceftriaxone (Rocephin)
Ceftriaxone is an alternative agent for penicillin-allergic patientsit
has lower efficacy against gram-positive organisms and higher
efficacy against resistant organisms. It arrests bacterial growth by
binding to one or more penicillin binding proteins.
Azithromycin (Zithromax)
Azithromycin acts by binding to the 50S ribosomal subunit of
susceptible microorganisms and blocks dissociation of peptidyl
tRNA from ribosomes, causing RNA-dependent protein synthesis
to arrest. Nucleic acid synthesis is not affected
Alternatives to penicillin
The efficacy of ceftriaxone and azithromycin in treating syphilis. -
Central nervous system (CNS) penetration and its similarity to penicillin
support the use of ceftriaxone in the treatment of syphilis dictates a 5-
to 7-day course of treatment for early syphilis.
The long half-life of azithromycin and its clinical efficacy in vitro against
syphilis support its use in treating early syphilis. At present, however,
clinical data remain insufficient to recommend its use.