Effectiveness of syphilis treatment using azithromycin and/or benzathine penicillin in Rakai, Uganda

Sex Transm Dis. 2005 Jan;32(1):1-6. doi: 10.1097/01.olq.0000148297.48590.d8.


Objective: The goal of this study was to assess azithromycin and/or benzathine penicillin for treatment of syphilis.

Methods: In a population-based study, participants with serologic syphilis (TRUST with TPHA confirmation) were offered 2.4 MU benzathine penicillin intramuscularly. Intervention arm participants received 1 g presumptive oral azithromycin. We assessed cure rates with penicillin or azithromycin given alone and in combination. Cure assessed after 10 months was defined as seroreversion or a 4-fold decrease in titer. The rate ratio (RR) of cure and 95% confidence intervals (95% CIs) were estimated by log binomial regression.

Results: Among 952 cases with syphilis, 18% received penicillin alone, 17% azithromycin only, and 65% dual treatment. The overall cure rate was 61%. Cure rates were lower in males compared with females (RR, 0.89; 95% CI, 0.80-0.99) and in subjects with initial titers > or =1:4 compared with < or =1:2 (RR, 0.77; 95% CI, 0.69-0.86). There was no significant differences in cure rates among HIV-positive and HIV-negative persons. With initial titers < or =1:2, there were no differences in cure rates by treatment regimen. However, with initial titers > or =1:4, significantly higher cure rates were observed with azithromycin alone (adjusted RR, 1.38; 95% CI, 0.97-1.96), and with dual treatment of azithromycin and benzathine penicillin (RR, 1.38; 95% CI, 1.03-1.87) compared with penicillin alone.

Conclusion: Azithromycin alone or in combination with penicillin achieved higher cure rates than penicillin alone in cases with a high initial TRUST titer. In low-titer infections, the 3 drug combinations were equally effective. HIV status did not affect cure rates.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Anti-Bacterial Agents / administration & dosage*
  • Azithromycin / administration & dosage*
  • Drug Administration Schedule
  • Female
  • HIV Infections*
  • Humans
  • Injections, Intramuscular
  • Male
  • Penicillin G Benzathine / administration & dosage*
  • Rural Health
  • Syphilis / drug therapy*
  • Syphilis / epidemiology
  • Syphilis / etiology
  • Treatment Outcome
  • Uganda / epidemiology


  • Anti-Bacterial Agents
  • Azithromycin
  • Penicillin G Benzathine