Syphilis management for tertiary stage

Overview
Tertiary syphilis refers to gumma and cardiovascular syphilis but not to all neurosyphilis. Patients who are not allergic to penicillin and have no evidence of neurosyphilis should be treated with the following regimen.

CDC Recommendations: Pharmacotherapy
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Recommended Regimen
1. Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervals.}}

Other Management Considerations
Patients who have symptomatic late syphilis should be given a CSF examination before therapy is initiated.

Penicillin Allergy: Alternative regimen
Patients allergic to penicillin should be treated in consultation with an infectious disease specialist.

Pregnancy
Pregnant patients who are allergic to penicillin should be desensitized and treated with penicillin.

Follow-Up
Limited information is available concerning clinical response and follow-up of patients who have tertiary syphilis.