Syphilis Treatment

The recommended treatment for syphilis is the antibiotic penicillin, specifically the type known as penicillin G benzathine (Bicillin L-A).

Penicillin has proven to be effective at killing Treponema pallidum, the bacterium that causes syphilis.

The cost of penicillin G benzathine varies. Most health insurance will cover it, with a possible copay depending on your plan. If you don’t have insurance, you may pay anywhere from $15 to $50 or more for the medication.

You should abstain from sexual contact until your treatment is completed and blood tests have confirmed that the infection is cured.

Your doctor may also recommend that you be tested for HIV, since having syphilis puts you at increased risk for this infection.

If diagnosed and treated early, syphilis is easily curable.

If you’ve been infected for less than a year, a single injection of penicillin G benzathine can halt the progression of syphilis.

If you’ve had the disease for more than a year, you may need additional doses. But even late-stage, or tertiary, syphilis can be treated, although penicillin cannot reverse any organ damage that has been caused by syphilis.

If neurosyphilis — syphilis affecting the brain or spinal cord — is diagnosed, an intensive regimen of penicillin lasting 10 to 14 days is necessary, and it may need to be repeated in some individuals.

If you’re allergic to penicillin, your doctor will suggest another antibiotic, but penicillin is the only recommended treatment for pregnant women with syphilis.

There are no home remedies to cure syphilis.

While penicillin is the drug of choice for syphilis, other antibiotics may be used in nonpregnant individuals who are allergic to penicillin. The CDC recommends that penicillin-allergic patients be treated in consultation with an infectious disease specialist. Alternatives to penicillin include the following:

• Doxycycline (Vibramycin) can be used to treat primary, secondary, and latent stages of syphilis.
• Tetracycline (Sumycin) can be used to treat primary, secondary, and latent stages of syphilis.
• Azithromycin (Zithromax) is effective against primary and secondary syphilis, but its use is limited in the United States because of antibiotic resistance.

If you’re pregnant and allergic to penicillin, your doctor may recommend a treatment called desensitization that can enable you to take the drug safely.

Depending on your history of allergic reactions to penicillin, your doctor may recommend that you be hospitalized for this process.

Desensitization typically involves taking steadily increasing doses of the penicillin over 4 to 12 hours, starting with a very small dose, to allow you to tolerate it safely.

If you’re treated for syphilis during your pregnancy, your newborn baby should be evaluated for congenital syphilis and may also need to receive antibiotic treatment.

You may experience what’s called a Jarisch-Herxheimer reaction — often shortened to “a Herxheimer reaction” or just “herxing” — on the first day you’re treated for syphilis. The reaction is believed to be caused by the release of endotoxin-like substances when large numbers of the bacteria that causes syphilis, Treponema pallidum, are killed by antibiotics.

Signs and symptoms of a Jarisch-Herxheimer reaction include:

• Fever and chills
• Nausea
• Muscle and joint aches
• Headache

These symptoms typically go away in a day or so in those with early-stage syphilis.

If you have syphilis, that means anyone with whom you’ve had sexual contact may have it, too. All sexual partners should be informed so they can be tested and treated if necessary.

Syphilis is contagious in the primary and secondary stages and may be contagious in the early latent stage, so both current and past sexual partners are at risk.

You can notify your sexual partner (or partners) yourself, or you can do it anonymously through a partner service program. Such programs are administered through state or county public health agencies, and your doctor can put you in touch with the partner service specialist in your area.