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
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.