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SYPHILIS: TREATMENT
The best treatment for syphilis is still one of the oldest antibiotics: penicillin. For the treatment of syphilis, penicillin must be given as an injection, not as an oral dose. The dosage and duration of treatment depend on the stage of the infection. For primary, secondary, and early latent syphilis, a single dose of penicillin usually eliminates the infection. Some people develop fever, chills, muscle aches, headache, and a worsening of the chancre or rash about eight hours after the shot; this reaction, called the Jarisch-Herxheimei reaction, is probably due to the rapid killing of the bacteria. It is temporary, usually resolving within twenty-four hours, and it does not lead to permanent problems. It is not an allergic reaction to penicillin.
In a person who has late latent syphilis or syphilis of unknown duration, injections are given weekly for three consecutive weeks. A person who develops neurosyphilis must be hospitalized and receive intravenous penicillin for ten to fourteen days.
To determine if treatment has been successful, follow-up visits for a VDRL or RPR test are essential. If the treatment was successful, then the test result will be lower than it was previously. If treatment has not been successful, it may be because the infection has involved the nervous system; as already indicated, neurosyphilis is treatable but requires a longer course of therapy as well as hospitalization for the administration of intravenous antibiotics.
People who are allergic to penicillin may be treated with other medications, such as doxycycline and tetracycline, if they have primary or secondary syphilis. However, in pregnant women the only recommended regimen is penicillin. The treatment may not be as effective in people infected with HIV as in those not infected, and for this reason close monitoring and follow-up testing are essential in HIV-positive persons.
The treatment for congenital syphilis (the infection of a newborn infant) must be coordinated with a specialist. The antibiotic used to treat children is also penicillin, and the course of treatment depends on the stage at which the child is diagnosed.
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