Neurosyphilis: An Unresolved Case of Meningitis

Table 2

Treatment of syphilis [3].

Syphilis stage or diagnosis	Primary therapy	Alternative therapy	Comment
Primary, secondary, and early latent syphilis	Penicillin G benzathine, 2.4 million units IM as a single dose	Doxycycline, 100 mg PO twice daily for 14 d or ceftriaxone, 1-2 g either IM or IV daily for 10–14 d or tetracycline, 100 mg PO four times daily for 14 d	—
Late latent syphilis	Penicillin G benzathine, 2.4 million units IM once weekly for 3 wk	Doxycycline, 100 mg PO twice daily for 28 d or tetracycline, 100 mg PO four times daily for 28 d	—
Neurosyphilis	Penicillin G aqueous, 18–24 million units IV daily (3-4 million units q 4 h or by continuous infusion) for 10–14 d	Procaine penicillin, 2.4 million units IM daily plus probenecid, 500 mg PO four times daily, both for 10–14 d or ceftriaxone, 2 g either IM or IV daily for 10–14 d	Follow-up treatment with 3 additional weekly injections of penicillin G benzathine, 2.4 million units IM
Tertiary syphilis (not neurosyphilis)	Penicillin G benzathine, 2.4 million units IM once weekly for 3 wk	—	Cerebrospinal fluid evaluation should be performed before therapy