IDSA Recommendations for Treating Treponema pallidum Infections (Syphilis) to Prevent Disease in HIV-AIDS

Early Stage (Primary, Secondary, and Early-Latent Syphilis) - Preferred Therapy:

 • Benzathine penicillin G 2.4 million U IM for 1 dose (AII)

Alternative Therapy (For Penicillin-Allergic Patients):

 • Doxycycline 100 mg PO BID for 14 days (BII), or

 • Ceftriaxone 1 g IM or IV daily for 10–14 days (BII), or

 • Azithromycin 2 g PO for 1 dose (BII)

Late-Latent (>1 year) or Latent of Unknown Duration - Preferred Therapy:

 • Benzathine penicillin G 2.4 million U IM weekly for 3 doses (AII)

Alternative Therapy (For Penicillin-Allergic Patients):

 • Doxycycline 100 mg PO BID for 28 days (BIII)

Late-Stage (Tertiary—Cardiovascular or Gummatous Disease) - Preferred Therapy:

 • Perform CSF examination to rule out neurosyphilis and obtain infectious diseases consultation to guide management

 • Benzathine penicillin G 2.4 million U IM weekly for 3 doses (AII)

Neurosyphilis, Otic, or Ocular Disease - Preferred Therapy:

 • Aqueous crystalline penicillin G, 18–24 million U per day, administered as 3–4 million U IV q4h or by continuous IV infusion for 10–14 days (AII) +/- benzathine penicillin G 2.4 million U IM weekly for 1 to 3 doses after completion of IV therapy (CIII)



#Syphilis #Treponema #pallidum #IDSA #Prevention #Treatment #management #opportunistic #infections #HIVAIDS #pharmacology