Efficacy of ceftriaxone and doxycycline in the treatment of early syphilis

Med Mal Infect. 2012 Jan;42(1):15-9. doi: 10.1016/j.medmal.2011.10.003. Epub 2011 Nov 25.


Introduction: An increase of syphilis cases has been recorded in the past few decades, especially among HIV-infected patients. These patients often present with concomitant primary and secondary lesions or extensive presentations of syphilis.

Objective: Our goal was to compare alternative regimens to the recommended penicillin treatment.

Method: We retrospectively studied 116 patient files (80% HIV1-infected) treated for a first episode of early syphilis.

Results: Patients mainly presented with symptoms of secondary syphilis. In 15.5% of the cases patients were asymptomatic and 17.2% of patients with secondary syphilis presented with neurologic or ophthalmic symptoms. Some less usual clinical presentations included diffuse polyadenopathy or isolated fever. The time to serological response was similar among those treated with benzathine-penicillin (n=52), ceftriaxone (n=49), or doxycycline (n=15).

Conclusion: Ceftriaxone and doxycycline could be suitable alternatives to penicillin in the treatment of early syphilis in HIV-infected patients. These two treatments have a concomitant effectiveness even for asymptomatic forms of neurosyphilis.

MeSH terms

  • Adult
  • Asymptomatic Diseases
  • Ceftriaxone / therapeutic use*
  • Doxycycline / therapeutic use*
  • Drug Evaluation
  • Early Diagnosis
  • Female
  • HIV Infections / complications
  • HIV-1
  • Humans
  • Male
  • Middle Aged
  • Neurosyphilis / complications
  • Neurosyphilis / drug therapy
  • Penicillin G Benzathine / therapeutic use
  • Recurrence
  • Retrospective Studies
  • Syphilis / complications
  • Syphilis / drug therapy*
  • Young Adult


  • Ceftriaxone
  • Doxycycline
  • Penicillin G Benzathine

Supplementary concepts

  • Syphilis, primary
  • Syphilis, secondary