What are the current treatment guidelines for syphilis in HIV-related disease

What are the current treatment guidelines for syphilis in HIV-related disease?

There has been much discussion of what constitutes adequate chemotherapy for syphilis in HIV-infected patients. The present recommendation is to use 2.4 million units of procaine penicillin daily for 10 to 14 days, with oral probenicid or IV penicillin for 10 days. Ceftriaxone 2g daily for 10 days has been proposed as an alternative, and the results of a comparative trial of standard IV penicillin versus IV ceftriaxone are currently under analysis. Because benzathine penicillin does not achieve treponemicidal levels in the CSF, it should not be used for treatment of neurosyphilis.
If compliance with therapy follow-up for serologic testing is likely to be problematic, supervised in-patient treatment may be the only certain way to ensure delivery of adequate amounts of antibiotic.