Table of ContentsView AllTable of ContentsPrescriptionsTreatment of PartnersSurgeryFrequently Asked QuestionsNext in Syphilis GuideWhat Is Syphilis?
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Table of Contents
Prescriptions
Treatment of Partners
Surgery
Frequently Asked Questions
Next in Syphilis Guide
Syphilisis a fairly commonsexually transmitted infection (STI), affecting more than 120,000 people in the United States each year.The mainstay of treatment ispenicillin, but other types ofantibioticsmay be appropriate as well.
Learn more about syphilis and the potential treatment options your healthcare provider may prescribe if you or your partner becomes infected.
Penicillin G
Penicillin Gis the antibiotic of choice in almost all cases. Penicillin G, also known asbenzylpenicillin, is used to treat many different types of bacterial infections. It is sometimes called a “peanut butter shot” because of its thick consistency.
There are different preparations of penicillin G, some of which have different consistencies and/or longer or shorter periods of action. The choice of preparation is important because certain types are better able to access tissues (like the brain and spinal cord) than others.
The choice and duration of treatment are largely based on thestage of the infection, known as the primary, secondary, latent, and tertiary stages. Each progressive stage has different symptoms and may need to be treated differently.
If there isneurosyphilis(syphilis of the brain),ocular syphilis(syphilis of the eyes), or otosyphilis (syphilis of the ear), an oral drug calledprobenecidis typically added to boost the effects of penicillin G.
In 2021, the Centers for Disease Control and Prevention (CDC) issued updated recommendations on the treatment of syphilis:
For otosyphilis, the steroid drug prednisone may also be added to reduce inflammation in the middle ear and help restore hearing.
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Alternatives to Penicillin
Other antibiotics may be used for people with syphilis who areallergic to penicillin. These include the antibioticsceftriaxone, doxycycline, and tetracycline.
The CDC recommends the following alternative treatment strategies for people with primary or secondary syphilis:
It is important to note that these antibiotics are only recommended to treat primary and secondary syphilis. Moreover,allergy testingshould be performed to confirm that the individual does, in fact, have a true penicillin allergy.
In advanced cases of syphilis, in which penicillin G remains the most effective option, a procedure known as drug desensitization may be used to prevent allergy in hypertensive people.
Drug Desensitization for PenicillinPenicillin desensitization is used to make a person less sensitive to penicillin. It involves exposing the individual to gradually increasing doses of penicillin every 15 to 20 minutes in a hospital. When the optimal dose is reached without triggering an allergic reaction, the treatment can begin.
Drug Desensitization for Penicillin
Penicillin desensitization is used to make a person less sensitive to penicillin. It involves exposing the individual to gradually increasing doses of penicillin every 15 to 20 minutes in a hospital. When the optimal dose is reached without triggering an allergic reaction, the treatment can begin.
There are cases where penicillin G is theonlyoption and the benefits of treatment may outweigh the risks. This includes the treatment of congenital syphilis in which theT. pallidumis passed from mother to child during pregnancy.
On the other hand, there is evidence that ceftriaxone may be a viable option for people with neurosyphilis when penicillin G is not an option.
Azithromycin, an antibiotic once commonly used to treat syphilis, is no longer recommended due to increasing rates of drug resistance (in which the bacteria resists the effects of the drug).
Treatment of Sexual Partners
According to the CDC, anyone who has had sexual contact with someone diagnosed with primary, secondary, or early latent syphilis should be notified and treated. Specifically:
If the sexual contact occurred less than 90 days before the diagnosis, the partner would be treated presumptively. This would be the case even if the partner’ssyphilis testis negative.
If the sexual contact occurred more than 90 days before the diagnosis, the partner could opt for a syphilis test if they choose. If the test result is negative, no treatment is required.
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Surgery and Specialist-Driven Procedures
Surgery is not a common part of the treatment for syphilis, but it may be needed in certain emergency situations.
This includes rare instances in which tertiary syphilis can cause anaortic aneurysm(the potentially deadly bulging of the main artery of the heart) or a highly destructive tumor in the brain known as a cerebral syphilitic gumma.
While surgery is avoided for most syphilitic gummas (mainly because they usually resolve with antibiotics), those in the brain are commonly treated to avoid potentially serious complications, including the loss of mobility and death.
Other gummas may be surgically removed if they arefungating(meaning that they are breaking open and causingtissue death). If left untreated, fungating gummas become infected and lead tosepsis(blood poisoning).
Summary
Penicillin G is the mainstay of treatment for syphilis. Depending on the stage of infection and other factors, the preparation, dose, and duration of therapy can vary. If penicillin G cannot be used due to a penicillin allergy, other antibiotics may be prescribed. The sexual partners of someone with syphilis should also be treated.
Surgery is sometimes needed for people with complications of tertiary syphilis, such as an aortic aneurysm or a brain mass known as a cerebral syphilitic gumma.
A Word From Verywell
Many people with syphilis have no idea that they’ve been infected. Because of this, the CDC recommends routine screening for people at high risk of infection or disease complications. These include pregnant persons,men who have sex with men (MSM), andpeople with HIV.
The CDC recommends that MSM and transgender women who have had a bacterial STI (specifically syphilis, chlamydia, or gonorrhea) diagnosed in the past 12 months or who have had condomless oral, anal, or vaginal sex should receive counseling that doxy PEP can be used as postexposure prophylaxis (PEP) to prevent these infections.
By getting tested, you can seek immediate, effective treatment if the test is positive, protecting yourself and others.
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An intramuscular injection of penicillin G is the preferred treatment. Generally, a single shot of long-acting benzathine penicillin G will cure a person of primary, secondary, or early latent syphilis.Late latent and tertiary syphilis are treated with three doses of penicillin G given at one-week intervals.
An intramuscular injection of penicillin G is the preferred treatment. Generally, a single shot of long-acting benzathine penicillin G will cure a person of primary, secondary, or early latent syphilis.
Late latent and tertiary syphilis are treated with three doses of penicillin G given at one-week intervals.
Even if there is an allergy, penicillin G is still the treatment of choice. Your healthcare provider may do allergy testing to verify if you are at true risk. If penicillin is not an option, other antibiotics may be explored, including ceftriaxone, doxycycline, and tetracycline.
Penicillin G is the only recommended treatment during pregnancy. Pregnant persons who are allergic to penicillin would need to undergo penicillin desensitization in a hospital.
Yes. If you have had sex with someone within 90 days of their syphilis diagnosis, you would be presumptively treated even if a syphilis test is negative.
You would need to abstain from sex until the syphilis sores (calledchancres) are fully healed. People with vaginas or those who were exposed through anal sex may need a physical exam as the sores may be internal and not readily seen.
A four-fold decrease in antibodies after one year is considered a treatment success.
12 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention.National overview - sexually transmitted disease surveillance.Centers for Disease Control and Prevention.Syphilis.Centers for Disease Control and Prevention.Sexually transmitted infections treatment guidelines, 2021.Ramchandani MS, Litvack JR, Marra CM.Otosyphilis: a review of the literature.Sex Transm Dis. 2020 May;47(5):296–300. doi:10.1097/OLQ.0000000000001155Centers for Disease Control and Prevention.Primary and secondary syphilis.Centers for Disease Control and Prevention.Syphilis during pregnancy.Buitrago-Garcia D, Marti-Carvajal AJ, Jimenez A, Conterno LO, Pardo R, Cochrane STI Group.Antibiotic therapy for adults with neurosyphilis.Cochrane Database Syst Rev.2019 May;2019(5):CD011399. doi:10.1002/14651858.CD011399.pub2Ignacio RAB, Koch LL, Dharireddy S, Godornes BC, Lukehart SA, Marazzo JM,Syphilis? An unusual cause of surgical emergency in a human immunodeficiency virus-infected man.Open Forum Infect Dis.2015 Sep;2(3):ofv094. doi:10.1093/ofid/ofv094Li C, Wang SJ, Tang GC, Liu LT, Chen GX.Neuroimaging findings of cerebral syphilitic gumma.Exp Ther Med.2019 Dec;18(6):4185–92. doi:10.3892/etm.2019.8089Centers for Disease Control and Prevention.Screening recommendations and considerations referenced in treatment guidelines and original sources.Centers For Disease Control and Prevention.CDC clinical guidelines on the use of doxycycline postexposure prophylaxis for bacterial sexually transmitted infection prevention, United States, 2024.Tipple C, Taylor GP.Syphilis testing, typing, and treatment follow-up: a new era for an old disease.Curr Opinion Infect Dis. 2015;28(1):53-60. doi:10.1097/QCO.0000000000000124
12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention.National overview - sexually transmitted disease surveillance.Centers for Disease Control and Prevention.Syphilis.Centers for Disease Control and Prevention.Sexually transmitted infections treatment guidelines, 2021.Ramchandani MS, Litvack JR, Marra CM.Otosyphilis: a review of the literature.Sex Transm Dis. 2020 May;47(5):296–300. doi:10.1097/OLQ.0000000000001155Centers for Disease Control and Prevention.Primary and secondary syphilis.Centers for Disease Control and Prevention.Syphilis during pregnancy.Buitrago-Garcia D, Marti-Carvajal AJ, Jimenez A, Conterno LO, Pardo R, Cochrane STI Group.Antibiotic therapy for adults with neurosyphilis.Cochrane Database Syst Rev.2019 May;2019(5):CD011399. doi:10.1002/14651858.CD011399.pub2Ignacio RAB, Koch LL, Dharireddy S, Godornes BC, Lukehart SA, Marazzo JM,Syphilis? An unusual cause of surgical emergency in a human immunodeficiency virus-infected man.Open Forum Infect Dis.2015 Sep;2(3):ofv094. doi:10.1093/ofid/ofv094Li C, Wang SJ, Tang GC, Liu LT, Chen GX.Neuroimaging findings of cerebral syphilitic gumma.Exp Ther Med.2019 Dec;18(6):4185–92. doi:10.3892/etm.2019.8089Centers for Disease Control and Prevention.Screening recommendations and considerations referenced in treatment guidelines and original sources.Centers For Disease Control and Prevention.CDC clinical guidelines on the use of doxycycline postexposure prophylaxis for bacterial sexually transmitted infection prevention, United States, 2024.Tipple C, Taylor GP.Syphilis testing, typing, and treatment follow-up: a new era for an old disease.Curr Opinion Infect Dis. 2015;28(1):53-60. doi:10.1097/QCO.0000000000000124
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Centers for Disease Control and Prevention.National overview - sexually transmitted disease surveillance.Centers for Disease Control and Prevention.Syphilis.Centers for Disease Control and Prevention.Sexually transmitted infections treatment guidelines, 2021.Ramchandani MS, Litvack JR, Marra CM.Otosyphilis: a review of the literature.Sex Transm Dis. 2020 May;47(5):296–300. doi:10.1097/OLQ.0000000000001155Centers for Disease Control and Prevention.Primary and secondary syphilis.Centers for Disease Control and Prevention.Syphilis during pregnancy.Buitrago-Garcia D, Marti-Carvajal AJ, Jimenez A, Conterno LO, Pardo R, Cochrane STI Group.Antibiotic therapy for adults with neurosyphilis.Cochrane Database Syst Rev.2019 May;2019(5):CD011399. doi:10.1002/14651858.CD011399.pub2Ignacio RAB, Koch LL, Dharireddy S, Godornes BC, Lukehart SA, Marazzo JM,Syphilis? An unusual cause of surgical emergency in a human immunodeficiency virus-infected man.Open Forum Infect Dis.2015 Sep;2(3):ofv094. doi:10.1093/ofid/ofv094Li C, Wang SJ, Tang GC, Liu LT, Chen GX.Neuroimaging findings of cerebral syphilitic gumma.Exp Ther Med.2019 Dec;18(6):4185–92. doi:10.3892/etm.2019.8089Centers for Disease Control and Prevention.Screening recommendations and considerations referenced in treatment guidelines and original sources.Centers For Disease Control and Prevention.CDC clinical guidelines on the use of doxycycline postexposure prophylaxis for bacterial sexually transmitted infection prevention, United States, 2024.Tipple C, Taylor GP.Syphilis testing, typing, and treatment follow-up: a new era for an old disease.Curr Opinion Infect Dis. 2015;28(1):53-60. doi:10.1097/QCO.0000000000000124
Centers for Disease Control and Prevention.National overview - sexually transmitted disease surveillance.
Centers for Disease Control and Prevention.Syphilis.
Centers for Disease Control and Prevention.Sexually transmitted infections treatment guidelines, 2021.
Ramchandani MS, Litvack JR, Marra CM.Otosyphilis: a review of the literature.Sex Transm Dis. 2020 May;47(5):296–300. doi:10.1097/OLQ.0000000000001155
Centers for Disease Control and Prevention.Primary and secondary syphilis.
Centers for Disease Control and Prevention.Syphilis during pregnancy.
Buitrago-Garcia D, Marti-Carvajal AJ, Jimenez A, Conterno LO, Pardo R, Cochrane STI Group.Antibiotic therapy for adults with neurosyphilis.Cochrane Database Syst Rev.2019 May;2019(5):CD011399. doi:10.1002/14651858.CD011399.pub2
Ignacio RAB, Koch LL, Dharireddy S, Godornes BC, Lukehart SA, Marazzo JM,Syphilis? An unusual cause of surgical emergency in a human immunodeficiency virus-infected man.Open Forum Infect Dis.2015 Sep;2(3):ofv094. doi:10.1093/ofid/ofv094
Li C, Wang SJ, Tang GC, Liu LT, Chen GX.Neuroimaging findings of cerebral syphilitic gumma.Exp Ther Med.2019 Dec;18(6):4185–92. doi:10.3892/etm.2019.8089
Centers for Disease Control and Prevention.Screening recommendations and considerations referenced in treatment guidelines and original sources.
Centers For Disease Control and Prevention.CDC clinical guidelines on the use of doxycycline postexposure prophylaxis for bacterial sexually transmitted infection prevention, United States, 2024.
Tipple C, Taylor GP.Syphilis testing, typing, and treatment follow-up: a new era for an old disease.Curr Opinion Infect Dis. 2015;28(1):53-60. doi:10.1097/QCO.0000000000000124
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What is Syphilis and How is it Treated?Get Familiar With the Symptoms of SyphilisHow Syphilis Is DiagnosedHow Syphilis Is Treated
What is Syphilis and How is it Treated?
Get Familiar With the Symptoms of Syphilis
How Syphilis Is Diagnosed
How Syphilis Is Treated
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