The 2024 UK guidelines for the management of syphilis are in line with current evidence and practice within the UK. Key updates are detailed at the start of the article. These guidelines are accompanied by the first UK guidelines for the management of syphilis in pregnant people and children, 2024.
SchaudinnFHoffmannE. Bericht Über das Vorkommen von Spirochaeten in syphilitischen Krankheitsprodukten und bei Papilloten. Arb Kaiserl Gesurndheisamte1905; 22: 527–532.
5.
LafondRLukehartSA. Biological basis for syphilis. Clin Microbiol Rev2006; 19: 29–49.
6.
SchoberPCGabrielGWhiteP, et al.How infectious is syphilis?Br J Vener Dis1983; 59: 217–219.
7.
HookEWMarraCM. Acquired syphilis in adults. N Engl J Med1992; 326: 1060–1069.
8.
AndersonJMindelAToveySJ, et al.Primary and secondary syphilis, 20 years' experience. 3: diagnosis, treatment, and follow up. Genitourin Med1989; 65: 239–243.
9.
Centers for Disease Control and Prevention. Transmission of primary and secondary syphilis by oral sex - Chicago, Illinois, 1998-2002. Morb Mortal Wkly Rep2004; 53: 966–968.
10.
PoultonMDeanGLWilliamsDI, et al.Surfing with spirochaetes: an ongoing syphilis outbreak in Brighton. Sex Transm Infect2001; 77: 319–321.
PetersenJGibinMSileB, et al.Identifying and interpreting spatiotemporal variation in diagnoses of infectious syphilis among men, England: 2009 to 2013. Sex Transm Infect2016; 92: 380–386.
MagnusonHJThomasEWOlanskyS, et al.Inoculation syphilis in human volunteers. Medicine (Baltim)1956; 35: 33–82.
20.
TownsJMLeslieDEDenhamI, et al.Painful and multiple anogenital lesions are common in men with Trepomema pallidum PCR-positive primary syphilis without herpes simplex coinfection: a cross-sectional clinic-based study. Sex Transm Infect2016; 92: 110–115.
21.
RompaloALawlorJSeamanP, et al.Modification of syphilitic genital ulcer manifestations by coexistent HIV infection. Sex Transm Dis2001; 28: 448–454.
22.
RompaloAJoesoefMO’DonnellJ, et al.Clinical manifestations of early syphilis by HIV status and gender: results of the syphilis and HIV study. Sex Transm Dis2001; 28: 158–165.
GjestlandT. The Oslo study of untreated syphilis; an epidemiologic investigation of the natural course of the syphilitic infection based upon a re-study of the Boeck-Bruusgaard material. Acta Derm Venereol Suppl1955; 35(Suppl 34): 3–368. (Annex I–LVI).
25.
LynnWLightmanS. Syphilis and HIV: a dangerous combination. Lancet Infect Dis2004; 4: 456–466.
26.
HiraSKPatelJSBhatSG, et al.Clinical manifestations of secondary syphilis. Int J Dermatol1987; 26: 103–107.
27.
ChapelTA. The signs and symptoms of secondary syphilis. Sex Transm Dis1980; 7: 161–164.
28.
Kassem YoussefHBlindAChouta NgahaF, et al.Secondary pulmonary syphilis: case report and review of literature. Ann Dermatol Venereol2018; 145: 278–287.
29.
ParkKHLeeMSHongIK, et al.Bone involvement in secondary syphilis: a case report and systematic review of the literature. Sex Transm Dis2014; 41: 532–537.
30.
MylonaEBaraboutisIPapastamopoulosV, et al.Gastric syphilis: a systematic review of published cases of the last 50 years. Sex Transm Dis2010; 37: 177–183.
31.
YimtaeKSrirompotongSLertsukprasertK. Otosyphilis: a review of 85 cases. Otolaryngol Head Neck Surg2007; 136: 67–71.
32.
GaudioPA. Update on ocular syphilis. Curr Opin Ophthalmol2006; 17: 562–566.
33.
MathewDSmitD. Clinical and laboratory characteristics of ocular syphilis and neurosyphilis among individuals with and without HIV infection. Br J Ophthalmol2020; 105: 70–74.
34.
ZhangTZhuYXuG. Clinical features and treatments of syphilitic uveitis: a systematic review and meta-analysis. J Ophthalmol2017; 2017: 6594849.
35.
CopeAMobleyVOliverS, et al.Ocular syphilis and HIV coinfection among syphilis patients in North Carolina, 2014-2016. Sex Transm Dis2019; 46: 80–85.
36.
MarraCMaxwellCSahiS, et al.Previous syphilis alters the course of subsequent episodes of syphilis. Clin Infect Dis2020; 74: e1–e5.
37.
KenyonCTsoumanisAOsbakK, et al.Repeat syphilis has a different immune response compared with initial syphilis: an analysis if biomarkers in two cohorts. Sex Transm Dis2018; 94: 180–186.
38.
CourjonJHubicheTDupinN, et al.Clinical aspects of syphilis reinfection in HIV-infected patients. Dermatology2015; 230: 302–307.
39.
KennedyJLBarnardJJPrahlowJA. Syphilitic coronary artery ostial stenosis resulting in acute myocardial infarction and death. Cardiology2006; 105: 25–29.
40.
WheelerHLAgarwalSGohBT. Dark ground microscopy and treponemal serological tests in the diagnosis of early syphilis. Sex Transm Infect2004; 80: 411–414.
41.
PalmerHHigginsSHerringA, et al.Use of PCR in the diagnosis of early syphilis in the United Kingdom. Sex Transm Infect2003; 79: 479–483.
42.
KoekABruistenSDierdorpM, et al.Specific and sensitive diagnosis of syphilis using a real-time PCR for Treponema pallidum. Clin Microbiol Infect2006; 12: 1233–1236.
43.
LeslieDAzzatoFKarapanagiotidisT, et al.Development of a real-time PCR assay to detect Treponema pallidum in clinical specimens and assessment of the assay's performance by comparison with serological testing. J Clin Microbiol2007; 45: 93–96.
44.
ZoechlingNSchluepenEMSoyerHP, et al.Molecular detection of Treponema pallidum in secondary and tertiary syphilis. Br J Dermatol1997; 136: 683–686.
45.
InagakiHKawaiTMiyataM, et al.Gastric syphilis: polymerase chain reaction detection of treponemal DNA in pseudolymphomatous lesions. Hum Pathol1996; 27: 761–765.
46.
MüllerMEwertIHansmannF, et al.Detection of Treponema pallidum in the vitreous by PCR. Br J Ophthalmol2007; 91: 592–595.
JanierMHegyiVDupinN, et al.2014 European guideline on the management of syphilis. J Eur Acad Dermatol Venereol2014; 28: 1581–1593.
50.
OsbakKKTsoumanisADe BaetselierI, et al.Role of IgM testing in the diagnosis and post-treatment follow-up of syphilis: a prospective cohort study. BMJ Open2020; 10: e035838.
51.
PastuszczakMKotnis-GąskaAJakubowiczB, et al.Utility of antitreponemal IgM testing in the diagnosis of early and repeat syphilis among HIV-infected and non-infected patients. Int J STD AIDS2018; 29: 890–894.
52.
BristowCCShannonCHerbst de CortinaS, et al.Use of oral fluid with a rapid treponemal test for syphilis evaluation. Sex Transm Dis2018; 45: e65–e67.
53.
PageMAtabaniSArumainayagamJ, et al.Are all blood-based postal sampling kits the same? A comparative service evaluation of the performance of dried blood spot and mini tube sample collection systems for postal HIV and syphilis testing. Sex Transm Infect2020; 97: 1–6.
54.
LugerA. Serological diagnosis of syphilis: current methods. In: YoungHMcMillanA (eds). Immunological diagnosis of sexually transmitted diseases. New York: Marcel Dekker, 1988, pp. 249–274.
55.
GeislerWM. The prozone phenomenon in syphilis testing. South Med J2004; 97: 327–328.
56.
SmithGHolmanRP. The prozone phenomenon with syphilis and HIV-1 co-infection. South Med J2004; 97: 379–382, Management of complications and late symptomatic (tertiary) disease.
57.
PeelingRWMabeyDKambML, et al.Syphilis. Nat Rev Dis Primers2017; 3: 17073.
58.
HookEW3rd. Syphilis. Lancet2017; 389: 1550–1557.
59.
DabisRRadcliffeK. What is the role of a full physical examination in the management of asymptomatic patients with late syphilis. Int J STD AIDS2012; 23: 901–902.
60.
WieselJRoseDNSilverAL, et al.Lumbar puncture in asymptomatic late syphilis. An analysis of the benefits and risks. Arch Intern Med1985; 145: 465–468.
61.
CurtisACCutlerJCGammonG, et al.Penicillin treatment of asymptomatic central nervous system syphilis. I. Probability of progression to symptomatic neurosyphilis. AMA Arch Derm1956; 74: 355–366.
62.
HardingASGhanemKG. The performance of cerebrospinal fluid treponemal-specific antibody tests in neurosyphilis: a systematic review. Sex Transm Dis2012; 39: 291–297.
63.
MarraCMMaxwellCLSmithSL, et al.Cerebrospinal fluid abnormalities in patients with syphilis: association with clinical and laboratory features. J Infect Dis2004; 189: 369–376.
64.
JanierMUnemoMDupinN, et al.2020 European guideline on the management of syphilis. J Eur Acad Dermatol Venereol2021; 35: 574–588.
65.
WöhrlSGeusauA. Neurosyphilis is unlikely in patients with late latent syphilis and a negative blood VDRL test. Acta Derm Venereol2006; 86: 335–339.
66.
MarraCMTantaloLCMaxwellCL, et al.The rapid plasma reagin test cannot replace the venereal disease research laboratory test for neurosyphilis diagnosis. Sex Transm Dis2012; 39: 453–457.
67.
LarsenSAHambleEAWobigGH, et al.Cerebrospinal serologic test for syphilis: treponemal and non-treponemal tests. In: MorisettRKurstakE (eds). Advances in sexually transmitted diseases. Utrecht, The Netherlands: VNU Science Press, 1985, pp. 157–162.
68.
IzzatNNBartruffJKGlicksmanJM, et al.Validity of the VDRL test on cerebrospinal fluid contaminated by blood. Br J Vener Dis1971; 47: 162–164.
69.
MarraCMMaxwellCLCollierAC, et al.Interpreting cerebrospinal fluid pleocytosis in HIV in the era of potent antiretroviral therapy. BMC Infect Dis2007; 7: 37.
70.
TomkinsAAhmadSCousinsD, et al.Screening for asymptomatic neurosyphilis in HIV: an observational study. Sex Transm Infect2018; 94: 337–339.
71.
HooshmandHEscobarMRKopfSW. Neurosyphilis; a study of 241 patients. JAMA1972; 219: 726–729.
CastroRPrietoESAguasMJ, et al.Evaluation of the Treponema pallidum particle agglutination technique (TP.PA) in the diagnosis of neurosyphilis. J Clin Lab Anal2006; 20: 233–238.
74.
LugerAFSchmidtBLKaulichM. Significance of laboratory findings for the diagnosis of neurosyphilis. Int J STD AIDS2000; 11: 224–234.
75.
LevchikNPonomarevaMSurganovaV, et al.Criteria for the diagnosis of neurosyphilis in cerebrospinal fluid: relationships with intrathecal immunoglobulin synthesis and blood-cerebrospinal fluid barrier dysfunction. Sex Transm Dis2013; 40: 917–922.
76.
MarksMLawrenceDKositzC, et al.Diagnostic performance of PCR assays for the diagnosis of neurosyphilis: a systematic review. Sex Transm Infect2018; 94: 585–588.
77.
DabisRRadcliffeK. Is it useful to perform a chest X-ray in asymptomatic patients with late syphilis. Int J STD AIDS2011; 22: 105–106.
78.
BradshawDPallawelaSNelsonM, et al.Otosyphilis: missed opportunities for early treatment?Sex Transm Infect2012; 88: 573.
79.
IdsoeOGutheTWillcoxRR. Penicillin in the treatment of syphilis. The experience of three decades. Bull World Health Organ1972; 47 Suppl(Suppl): 1–68.
EagleHFleischmanRMusselmanAD. The effective concentrations of penicillin in vitro and in vivo for streptococci, pneumococci, and Treponema pallidum. J Bacteriol1950; 59: 625–643.
82.
SinghAERomanowskiB. Syphilis: review with emphasis on clinical, epidemiologic, and some biologic features. Clin Microbiol Rev1999; 12: 187–209.
83.
LukehartSAHookEWBaker-ZanderSA, et al.Invasion of the central nervous system by Treponema pallidum: implications for diagnosis and treatment. Ann Intern Med1988; 109: 855–862.
84.
MohrJAGriffithsWJacksonR, et al.Neurosyphilis and penicillin levels in cerebrospinal fluid. JAMA1976; 236: 2208–2209.
85.
DucasJRobsonHG. Cerebrospinal fluid penicillin levels during therapy for latent syphilis. JAMA1981; 246: 2583–2584.
86.
PolnikornNWitoonpanichRVorachitM, et al.Penicillin concentrations in cerebrospinal fluid after different treatment regimens for syphilis. Br J Vener Dis1980; 56: 363–367.
87.
GoldmeierDWaterworthPM. Penetration of penicillin into the cerebrospinal fluid of patients with latent syphilis. Pharmatherapeutica1981; 3: 14–17.
88.
GohBTSmithGWSamarasingheL, et al.Penicillin concentrations in serum and cerebrospinal fluid after intramuscular injection of aqueous procaine penicillin 0.6 MU with and without probenecid. Br J Vener Dis1984; 60: 371–373.
89.
LöwhagenGBBrorsonJEKaijserB. Penicillin concentrations in cerebrospinal fluid and serum after intramuscular, intravenous, and oral administration to syphilitic patients. Acta Derm Venereol1983; 63: 53–57.
90.
SmithNHMusherDMHuangDB, et al.Response of HIV infected patients with asymptomatic syphilis to intensive intramuscular therapy with ceftriaxone or procaine penicillin. Int J STD AIDS2004; 15: 328–332.
HarshanVJayakumarW. Doxycycline in early syphilis: a long term follow up. Indian J Dermatol1982; 27: 119–124.
93.
GhanemKGErbeldingEJChengWW, et al.Doxycycline compared with benzathine penicillin for the treatment of early syphilis. Clin Infect Dis2006; 42: e45.
94.
TsaiJCLinYHLuPL, et al.Comparison of serological response to doxycycline versus benzathine penicillin G in the treatment of early syphilis in HIV-infected patients: a multi-center observational study. PLoS One2014; 9: e109813.
95.
Salado-RasmussenKHoffmannSCowanS, et al.Serological response to treatment of syphilis with doxycycline compared with penicillin in HIV-infected individuals. Acta Derm Venereol2016; 96: 807–811.
96.
XiaoHLiuDLiZ, et al.Comparison of doxycycline and benzathine penicillin G for the treatment of early syphilis. Acta Dermatovenerol Croat2017; 25: 107–111.
97.
ZenilmanJMRandSBarditchP, et al.Asymptomatic neurosyphilis after doxycycline therapy for early latent syphilis. Sex Transm Dis1993; 20: 346–347.
98.
YimCWFlynnNMFitzgeraldFT. Penetration of oral doxycycline into the cerebrospinal fluid of patients with latent or neurosyphilis. Antimicrob Agents Chemother1985; 28: 347–348.
99.
PhilipsonASabathLDCharlesD. Transplacental passage of erythromycin and clindamycin. N Engl J Med1973; 288: 1219–1221.
100.
RiednerGRusizokaMToddJ, et al.Single-dose azithromycin versus penicillin G benzathine for the treatment of early syphilis. N Engl J Med2005; 353: 1236–1244.
101.
HookEWBehetsFVan DammeK, et al.A phase III equivalence trial of azithromycin versus benzathine penicillin for treatment of early syphilis. J Infect Dis2010; 201: 1729–1735.
102.
LukehartSGodornesCMoliniB, et al.Macrolide resistance in Treponema pallidum in the United States and Ireland. N Engl J Med2004; 351: 154–158.
103.
StammLVBergenHL. A point mutation associated with bacterial macrolide resistance is present in both 23S rRNA genes of an erythromycin-resistant Treponema pallidum clinical isolate. Antimicrob Agents Chemother2000; 44: 806–807.
104.
SteeleRW. Ceftriaxone therapy of meningitis and serious infections. Am J Med1984; 77: 50–53.
105.
MarraCMSlatterVTartaglioneTA, et al.Evaluation of aqueous penicillin G and ceftriaxone for experimental neurosyphilis. J Infect Dis1992; 165: 396–397.
106.
HookEWBaker-ZanderSAMoskovitzBL, et al.Ceftriaxone therapy for asymptomatic neurosyphilis. Case report and Western blot analysis of serum and cerebrospinal fluid IgG response to therapy. Sex Transm Dis1986; 13(3 Suppl): 185–188.
107.
HookEWRoddyREHandsfieldHH. Ceftriaxone therapy for incubating and early syphilis. J Infect Dis1988; 158: 881–884.
108.
KatsambasAAdoniouCKatsarouA, et al.Comparative study of ceftriaxone and benzathine penicillin G in the treatment of primary and secondary syphilis. Chemioterapia1987; 6(2 Suppl): 549–550.
109.
MoorthyTTLeeCTLimKB, et al.Ceftriaxone for treatment of primary syphilis in men: a preliminary study. Sex Transm Dis1987; 14: 116–118.
110.
DowellMERossPGMusherDM, et al.Response of latent syphilis or neurosyphilis to ceftriaxone therapy in persons infected with human immunodeficiency virus. Am J Med1992; 93: 481–488.
111.
AugenbraunMWorkowskiK. Ceftriaxone therapy for syphilis: report from the emerging infections network. Clin Infect Dis1999; 29: 1337–1338.
112.
LiangZChenY-PYangC-S, et al.Meta-analysis of ceftriaxone compared with penicillin for the treatment of syphilis. Int J Antimicrob Agents2016; 47: 6–11.
113.
CaoYSuXWangQ, et al.A multicenter study evaluating ceftriaxone and benzathine penicillin G as treatment agents for early syphilis in jiangsu, China. Clin Infect Dis2017; 65: 1683–1688.
114.
HaynesAMGiacaniLMayansMV, et al.Efficacy of linezolid on Treponema pallidum, the syphilis agent: a preclinical study. EBioMedicine2021; 65: 103281.
115.
BealeMAMarksMColeMJ, et al.Global phylogeny of Treponema pallidum lineages reveals recent expansion and spread of contemporary syphilis. Nat Microbiol2021; 6: 1549–1560.
116.
SanchezAMayslichCMaletI, et al.Surveillance of antibiotic resistance genes in Treponema pallidum subspecies pallidum from patients with early syphilis in France. Acta Derm Venereol2020; 100: adv00221.
117.
NishikiSArimaYKanaiM, et al.Epidemiology, molecular strain types, and macrolide resistance of Treponema pallidum in Japan, 2017-2018. J Infect Chemother2020; 26: 1042–1047.
118.
ShannSWilsonJ. Treatment of neurosyphilis with ceftriaxone. Sex Transm Infect2003; 79: 415–416.
119.
MarraCMBoutinPMcArthurJC, et al.A pilot study evaluating ceftriaxone and penicillin G as treatment agents for neurosyphilis in human immunodeficiency virus-infected individuals. Clin Infect Dis2000; 30: 540–544.
120.
GudjonssenHSkogE. The effect of prednisolone on the Jarisch-Herxheimer reaction. Acta Derm Venereol1968; 48: 15–18.
121.
GracianskyPDGrupperC. Cortisone in the prevention of the Herxheimer reaction. Br J Vener Dis1961; 37: 247–251.
122.
ZifkoULindnerKWimbergerD, et al.Jarisch-Herxheimer reaction in a patient with neurosyphilis. J Neurol Neurosurg Psychiatry1994; 57: 865–867.
123.
FathilahJChooMM. The Jarisch-Herxheimer reaction in ocular syphilis. Med J Malaysia2003; 58: 437–439.
124.
DobbinJMPerkinsJH. Otosyphilis and hearing loss: response to penicillin and steroid therapy. Laryngoscope1983; 93: 1540–1543.
125.
GleichLLLinstromCJKimmelmanCP. Otosyphilis: a diagnostic and therapeutic dilemma. Laryngoscope1992; 102: 1255–1259.
126.
MarraCMMaxwellCLTantaloLC, et al.Normalization of serum rapid plasma reagin titer predicts normalization of cerebrospinal fluid and clinical abnormalities after treatment of neurosyphilis. Clin Infect Dis2008; 47: 893–899.
127.
WibisonoOIdrisIDjawadK. Malignant syphilis: a systematic review of the case reports published in 2014-2018. Actas dermo-sifiliográficas. English Edition. 2021; 112(8): 725–734. DOI:10.1016/j.adengl.2021.05.014.
128.
NieuwenburgSASprengerRJSchim van der LoeffMF, et al.Clinical outcomes of syphilis in HIV-negative and HIV-positive MSM: occurrence of repeat syphilis episodes and non-treponemal serology responses. Sex Transm Infect2022; 98: 95–100.
129.
AllenHKKirwanPBrownAE, et al.Does being on HIV antiretroviral therapy increase the risk of syphilis? An analysis of a large national cohort of MSM living with HIV in England 2009-2016. Sex Transm Infect2021; 97: 221–225.
130.
RekartMLNdifonWBrunhamRC, et al.A double-edged sword: does highly active antiretroviral therapy contribute to syphilis incidence by impairing immunity to Treponema pallidum?Sex Transm Infect2017; 93: 374–378.
131.
PalaciosRJiménez-OñateFAguilarM, et al.Impact of syphilis infection on HIV viral load and CD4 cell counts in HIV-infected patients. J Acquir Immune Defic Syndr1999; 44: 356–359.
132.
SeñaACZhangX-HLiT, et al.A systematic review of syphilis serological treatment outcomes in HIV-infected and HIV-uninfected persons: rethinking the significance of serological non-responsiveness and the serofast state after therapy. BMC Infect Dis2015; 15: 479.
133.
GhanemKGMooreRDRompaloAM, et al.Antiretroviral therapy is associated with reduced serologic failure rates for syphilis among HIV-infected patients. Clin Infect Dis2008; 47: 258–265.
134.
GanesanAMesnerOOkuliczJF, et al.A single dose of benzathine penicillin G is as effective as multiple doses of benzathine penicillin G for the treatment of HIV-infected persons with early syphilis. Clin Infect Dis2015; 60: 653–660.
135.
Dionne-OdomJKaritaEKilembeW, et al.Syphilis treatment response among HIV-discordant couples in Zambia and Rwanda. Clin Infect Dis2013; 56: 1829–1837.
136.
FarhiDBenhaddouNGrangeP, et al.Clinical and serologic baseline and follow-up features of syphilis according to HIV status in the post-HAART era. Medicine2009; 88: 331–340.
137.
Costa-SilvaMAzevedoCAzevedoF, et al.Early syphilis treatment in HIV-infected patients: single dose vs. three doses of benzathine penicillin G. J Eur Acad Dermatol Venereol2016; 30: 1805–1809.
138.
RolfsRTJoesoefMRHendershotEF, et al.A randomized trial of enhanced therapy for early syphilis in patients with and without human immunodeficiency virus infection. The Syphilis and HIV Study Group. N Engl J Med1997; 337: 307–314.
139.
AndradeRRodriguez-BarradasMCYasukawaK, et al.Single dose versus 3 doses of intramuscular benzathine penicillin for early syphilis in HIV: a randomized clinical trial. Clin Infect Dis2017; 64: 759–764.
140.
AntonioMCubaGTVasconcelosRP, et al.Natural experiment of syphilis treatment with doxycycline or benzathine penicillin in HIV-infected patients. AIDS2019; 33: 77–81.
141.
RenMSzadkowskiLWalmsleySL. Deciphering the serological response to syphilis treatment in men living with HIV. AIDS2020; 34: 2089–2096.
142.
González-LópezJJGuerreroMLFLujánR, et al.Factors determining serologic response to treatment in patients with syphilis. Clin Infect Dis2009; 49: 1505–1511.
143.
GhanemKGMooreRDRompaloAM, et al.Neurosyphilis in a clinical cohort of HIV-1-infected patients. AIDS2008; 22: 1145–1151.
144.
BrangerJvan der MeerJTvan KetelRJ, et al.High incidence of asymptomatic syphilis in HIV-infected MSM justifies routine screening. Sex Transm Dis2009; 36: 84–85.
145.
WeinerALWilzbachCALudlowCE. Ambulatory penicillin therapy of syphilis in a public health clinic – report on four hundred and two patients treated in 1949 and 1950. Ohio Med1951; 47: 720–724.
146.
PerdrupA. Penicillin treatment of early syphilis. A follow-up study of 213 patients observed for one to eleven years. Comparison between the effect of six and twelve million units. Acta Derm Venereol1960; 40: 340–357.
147.
CroweGTheodoreCForsterGE, et al.Acceptability and compliance with daily injections of procaine penicillin in the outpatient treatment of syphilis-treponemal infection. Sex Transm Dis1997; 24: 127–130.
148.
DaiTQuRLiuJ, et al.Efficacy of doxycycline in the treatment of syphilis. Antimicrob Agents Chemother2016; 61: e01092.
149.
OnodaY. Clinical evaluation of amoxycillin in the treatment of syphilis. J Int Med Res1979; 7: 539–545.
150.
GoldmanJN. Clinical experience with amicillin and probenecid in the management of treponeme-associated uveitis. Trans Am Acad Ophthalmol Otolaryngol1970; 74: 509–514.
151.
MorrisonREHarrisonSMTramontEC. Oral amoxycillin, an alternative treatment for neurosyphilis. Genitourin Med1985; 61: 359–362.
152.
DunlopEMAl-EgailySSHouangET. Production of treponemicidal concentration of penicillin in cerebrospinal fluid. Br Med J1981; 283: 646.
153.
PatelIHKaplanSA. Pharmacokinetic profile of ceftriaxone in man. Am J Med1984; 77: 17–25.
154.
ChisholmCAKatzVLMcDonaldTL, et al.Penicillin desensitization in the treatment of syphilis during pregnancy. Am J Perinatol1997; 14: 553–554.
155.
WendelGDStarkBJJamisonRB, et al.Penicillin allergy and desensitization in serious infections during pregnancy. N Engl J Med1985; 312: 1229–1232.
156.
McCleanHRadcliffeKSullivanA, et al.2012 BASHH statement on partner notification for sexually transmissible infections. Int J STD AIDS2013; 24: 253–261.
157.
RenR-XWangL-NZhengH-Y, et al.No improvement in serological response among serofast latent patients retreated with benzathine penicillin. Int J STD AIDS2016; 27: 58–62.