Syphilis Treatment and Care

What is the treatment for syphilis?

There are no home remedies or over-the-counter drugs that will cure syphilis, but syphilis is easy to cure in its early stages. A single intramuscular injection of long acting Benzathine penicillin G (2.4 million units administered intramuscularly) will cure a person who has primary, secondary or early latent syphilis. Three doses of long acting Benzathine penicillin G (2.4 million units administered intramuscularly) at weekly intervals is recommended for individuals with late latent syphilis or latent syphilis of unknown duration. Treatment will kill the syphilis bacterium and prevent further damage, but it will not repair damage already done.

Selection of the appropriate penicillin preparation is important to properly treat and cure syphilis. Combinations of some penicillin preparations (e.g., Bicillin C-R, a combination of benzathine penicillin and procaine penicillin) are not appropriate treatments for syphilis, as these combinations provide inadequate doses of penicillin.

Although data to support the use of alternatives to penicillin is limited, options for non-pregnant patients who are allergic to penicillin may include doxycycline, tetracycline, and for neurosyphilis, ceftriaxone. These therapies should be used only in conjunction with close clinical and laboratory follow-up to ensure appropriate serological response and cure.

Persons who receive syphilis treatment must abstain from sexual contact with new partners until the syphilis sores are completely healed. Persons with syphilis must notify their sex partners so that they also can be tested and receive treatment if necessary.

Treatment Guidelines and Updates

• 2015 STD Treatment Guidelines – Syphilis (June 4, 2015)
  • Syphilis During Pregnancy
  • Congenital Syphilis
• Clinical Advisory: Ocular Syphilis in the United States (Updated April 16, 2015)

Resources for Clinicians

• The Diagnosis, Management and Prevention of Syphilis: An Update and Reviewpdf iconexternal icon – A clinical guidance document for use in the diagnosis and management of syphilis. Based on content from the 2015 CDC STD Treatment Guidelines, and developed by the NYC Department of Health and Mental Hygiene Bureau of Sexually Transmitted Infections and the NYC STD Prevention Training Center. (March 2019)
• Syphilis Pocket Guide for Providerspdf icon – Updated booklet for providers containing need-to-know details on the diagnosis, treatment, and prevention of syphilis. (November 30, 2017)
• Syphilis Self-Study Moduleexternal icon – An online learning experience that helps users learn how to manage syphilis. It is continuously updated and integrates the most recent STD Treatment Guidelines. Free CME/CNE available. (November 1, 2017)
• The Rising Tide of Syphilis: Coming to a Patient Near Youexternal icon (July 18, 2017)
• Congenital Syphilis Is on the Rise? Reviewing Prevention Stepsexternal icon (July 19, 2016)
• Suggested Reporting Language for Syphilis Serology Testingpdf iconexternal icon (May 19, 2016)
• Medscape Commentary: Keep an Eye Out for Ocular Syphilisexternal icon (added February 11, 2016)