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CDC Syphilis Treatment Guidelines, 2010

  • Penicillin G, administered parenterally, is the preferred drug for treating all stages of syphilis. 

  • Combinations of benzathine penicillin, procaine penicillin, and oral penicillin preparations are not considered appropriate for the treatment of syphilis.

  • Pregnant women should be treated with the penicillin regimen appropriate for their stage of infection.

  • Click here to view syphilis treatment guidelines for HIV-infected persons.

Primary Syphilis

  • Recommended Regimen for Adults
    Benzathine penicillin G 2.4 million units IM in a single dose
  • Recommended Regimen for Infants and Children
    Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of 2.4 million units in a single dose

 

Latent Syphilis

  • Recommended Regimens for Adults
    Early Latent Syphilis
    Benzathine penicillin G 2.4 million units IM in a single dose
    Late Latent Syphilis or Latent Syphilis of Unknown Duration
    Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervals
  • Recommended Regimens for Children
    Early Latent Syphilis

    Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of 2.4 million units in a single dose
    Late Latent Syphilis or Latent Syphilis of Unknown Duration
    Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of 2.4 million units, administered as 3 doses at 1-week intervals (total 150,000 units/kg up to the adult total dose of 7.2 million units)

​Tertiary Syphilis

  • Recommended Regimen
    Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervals
     

Neurosyphilis

  • Recommended Regimen
    Aqueous crystalline penicillin G 18–24 million units per day, administered as 3–4 million units IV every 4 hours or continuous infusion, for 10–14 days
  • Alternative Regimen
    Procaine penicillin 2.4 million units IM once daily
    PLUS
    Probenecid 500 mg orally four times a day, both for 10–14 days