Syphilis treatment: old and new

Expert Opin Pharmacother. 2005 Oct;6(13):2271-80. doi: 10.1517/14656566.6.13.2271.


Syphilis has challenged scientists and clinicians since its first appearance in the late 1400s and debate continues to surround the best practice in management. Difficulties in defining the goals of successful treatment have contributed to problems in determining recommendations for the ideal management. Treatment regimens currently in use were developed before randomised controlled trials became standard. This, combined with national differences in disease definition, staging and varying interpretations of the studies, as well as the emergence of complicating comorbid conditions, such as HIV, has resulted in a lack of consensus for treatment. This paper will discuss the history and current treatment of syphilis focusing on dilemmas faced by clinicians today, including the emergence of a resistant strain. Despite the difference between current national guidelines, penicillin G largely remains the treatment of choice. Close follow up, monitoring and ensuring adequate compliance remain the most important aspects in the treatment of syphilis.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / therapeutic use*
  • Ceftriaxone / therapeutic use
  • Doxycycline / therapeutic use
  • Drug Hypersensitivity / etiology
  • Female
  • HIV Infections / complications
  • HIV Infections / drug therapy*
  • Humans
  • Infant, Newborn
  • Patient Compliance
  • Penicillin G / adverse effects
  • Penicillin G / therapeutic use*
  • Practice Guidelines as Topic
  • Pregnancy
  • Pregnancy Complications, Infectious / drug therapy*
  • Randomized Controlled Trials as Topic
  • Syphilis / complications
  • Syphilis / drug therapy*


  • Anti-Bacterial Agents
  • Ceftriaxone
  • Doxycycline
  • Penicillin G