Recommended Regimen

Alternative Regimen

Doxycycline 200 mg PO BID x 7 days

Azithromycin 1.0 gm once

Ofloxacin 300 mg PO BID x 7 days

Levofloxacin 500 mg PO x 7 days

Erythromycin base 500 mg PO QID x 7 days

ESS 800 mg PO QID x 7 days

Recommended Regimen

Alternative Regimen

Ceftriaxone 125 mg IM once

Ciprofloxacin 500 mg PO once

Cefixime 400 mg PO once

Ofloxacin 400 mg PO once

Levofloxacin 250 mg PO once

Plus (for C. trachomatis coinfection) Doxycycline 200 mg PO BID x 7 days

Azithromycin 1.0 gm once Levofloxacin 500 mg PO x 7 days (slow elimination, t1/2 ~5d, costly).

Spectinomycin 2.0 gm IM once (if allergic to cephalosporines and quinolones)

Ceftizoxime 500 mg IM once

Cefotaxime 500 mg IM once

Cefoxitin 2.0 gm IM once + 1 gm probenecid PO

Gatifloxacin 400 mg PO once

Lomefloxacin 400 mg PO once

Norfloxacin 800 mg PO once

Alternative tx for C. trachomatis coinfection

Ofloxacin 300 mg PO BID x 7 days Erythromycin base 500 mg PO QID x 7 days

ESS 800 mg PO QID x 7 days

Recommended Regimen

Follow-up Serology

Less than 1 year’s duration

Benzathine penicillin G 2.4 million units IM once Penicillin allergic

Doxycycline 200 mg PO BID x 2 weeks

Tetracycline 500 mg PO QID x 2 weeks

Erythromycin 500 mg PO QID x 2 weeks

Quantitative nontreponemal tests at 3 &

6 & 12 for early latent – looking for the 4-fold change.

Syphilis of more than 1 year’s duration

Benzathine penicillin G 2.4 million units IM once

a week for 3 successive weeks.

Penicillin allergic

Doxycycline 100 mg PO BID x 2 weeks

Tetracycline 500 mg PO QID x 2 weeks

Quantitative nontreponemal tests at 6 & 12 for late latent

Neurosyphilis

Penicillin G 3-4 million units IV q4h x 14d