Treatment:

The treatment of syphilis is determined by the length of time the person has been infected.

Syphilis can be treated with antibiotics such as penicillin, G benzathine, doxycycline, or tetracycline (for patients who are allergic to penicillin). Length of treatment depends on the extent of the infection and factors such as the person's overall health.

For treating syphilis during pregnancy, only penicillin is recommended. Tetracycline cannot be used because it is toxic to the fetus, and erythromycin may fail to prevent the spread of the infection (congenital syphilis) to the fetus. Penicillin-allergic individuals should be desensitized and then treated with penicillin.

Several hours following treatment of early stages of syphilis, some individuals may undergo a febrile reaction called Jarisch-Herxheimer reaction. This is thought to be caused by the release into the circulation of material from dead or dying spirochetes. Symptoms of this reaction include:

• Chills
• Fever
• General feeling of being ill (malaise)
• Generalized joint aches (arthralgia)
• Generalized muscle aches (myalgia)
• Headache
• Nausea

These symptoms usually disappear within 24 hours.

Follow-up blood tests must be done 3, 6, 12, and 24 months after treatment to ensure that the infection has been eliminated.

Individuals with primary or secondary syphilis should abstain from sex until they have been treated. Syphilis is extremely contagious in the primary and secondary stages.

Expectations (prognosis):

Late syphilis may be permanently disabling and may lead to death.

Complications:

• Aneurysms
• Heart valve disease
• Neurosyphilis
• Syphilis infection of the heart

Calling your health care provider:

Untreated syphilis can result in serious health problems. It is very important that you tell your doctor if you think you might have had syphilis, even if it was many years ago.