Pharmacological Treatments for Syphilis

Introduction

Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. It progresses through multiple stages and can have severe long-term effects if left untreated.

Pharmacological Management

First-Line Treatment: Penicillin

• Benzathine Penicillin G: Administered intramuscularly for primary and secondary syphilis.
• Aqueous Penicillin G: Used for neurosyphilis and congenital syphilis.

Alternative Therapies

For patients allergic to penicillin, alternative antibiotic regimens include:

• Doxycycline: A tetracycline antibiotic used as a second-line treatment.
• Azithromycin: Macrolide therapy, though resistance has been observed.

Drug Resistance in Treponema pallidum

Emerging Concerns

Recent studies indicate growing resistance, particularly to macrolides such as azithromycin, linked to mutations in the 23S rRNA gene.

Clinical Implications

Resistance necessitates careful antibiotic selection and may lead to increased reliance on penicillin-based treatments.

Conclusion

While penicillin remains the gold standard, alternative antibiotics must be used cautiously given the rise in drug-resistant Treponema pallidum strains.