Emerging treatments

Your Organisational Guidance

ebpracticenet urges you to prioritise the following organisational guidance:

Diagnose en aanpak van syfilisPublished by: KCELast published: 2020Diagnostic et prise en charge de la syphilisPublished by: KCELast published: 2020

Azithromycin

Azithromycin may be an option in special circumstances only when local susceptibility to azithromycin is likely.[7][Evidence C]​​  Data regarding resistance to azithromycin for treating syphilis in specific settings are not available, and will likely remain unknown. The World Health Organization Guideline Development Group notes concerns about the risk of azithromycin resistance in Treponema pallidum.[7]​ The Centers for Disease Control and Prevention (CDC) and the British Association for Sexual Health and HIV (BASHH) recommend against the use of azithromycin due to macrolide resistance.[4]​[8]​​

Ceftriaxone

Ceftriaxone has been used to treat early syphilis (primary, secondary, and early latent), late latent syphilis, and neurosyphilis. Results from meta-analyses have found ceftriaxone to be non-inferior to penicillin in terms of cure rates, relapse rates, and serofast rates.[105][106]​  In patients with penicillin allergy, there is a low risk of allergic reaction with ceftriaxone due to cross-sensitivity, and it may be given in patients with no history of anaphylaxis.[4]​ In the UK, BASHH recommends that ceftriaxone is appropriate for most cases when penicillin cannot be used, including during pregnancy. The recommended dose and duration of ceftriaxone treatment depends on the stage of infection.[4][73]​ However, the CDC recommends that pregnant women with syphilis infection and a penicillin allergy should be desensitized and treated with parenteral benzylpenicillin because this is the only treatment with documented efficacy during pregnancy.[8]

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