Pharmacologic Highlights

Medication or Drug Class




Benzathine penicillin G

2.4 million units IM, single dose (some recommend a second dose 1 wk later)

Antibiotic, penicillin

Effective for primary, secondary, and latent syphilis of less than 1 yr duration

Benzathine penicillin G

2.4 million units, IM, weekly, for 3 doses

Antibiotic, penicillin

Effective treatment for latent syphilis of more than 1 yr duration, or cardiovascular or late benign syphilis

Aqueous crystalline penicillin G

2-4 million units IV q 4 hr for 10-14 days

Antibiotic, penicillin

Recommended to treat neurosyphilis


Provide care for the patient's lesions. Keep them clean and dry. Properly dispose of contaminated materials from draining lesions. Use universal precautions when you come in direct contact with the patient, when collecting specimens, and when caring for the lesions.

Focus on prevention. Educate patients about the course of the disease and the need to return for follow-up treatment or blood tests. Patients need to understand that although their lesions may heal, the infection may not be gone. Approximately 10% of patients do not respond to the first round of antibiotics, so additional treatment may be necessary.

Teach patients how to reduce risk factors to prevent future infections by limiting the number of sexual partners and practicing safer sex. Using condoms with spermicide and inspecting partners for any rashes or lesions may reduce exposure to the disease. Patients need ongoing emotional support to make lifestyle changes. Explain the need for regular laboratory testing (VDRL) every 3 months for 2 years to detect a relapse. Urge patients in the latent or late stages to have blood tests every 6 months for 2 years. Explain the relationship between human immunodeficiency virus (HIV) and syphilis and perform HIV testing if the patient wishes.

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