Syphilis / Neurosyphilis, Ocular Syphilis, and Otosyphilis
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
Procaine penicillin G 2.4 million units IM once daily
Probenecid 500 mg orally 4 times/day, both for 10–14 days
Persons with HIV infection and neurosyphilis should be treated according to the recommendations for persons with neurosyphilis and without HIV infection.
Pregnant women should be treated with the recommended penicillin regimen for their stage of infection.
Parenteral penicillin G is the only therapy with documented efficacy for syphilis during pregnancy. Pregnant women who are allergic to penicillin should be desensitized and treated with penicillin G. Skin testing or oral graded penicillin dose challenge might be helpful in identifying women at risk for acute allergic reactions.