- Syphilis can have an atypical course in HIV-infected patients, and treatment failures are more frequent in this population.
- A spinal tap is recommended in HIV-infected patients with latent syphilis to rule out neurosyphilis.
- Benzathine penicillin, 2.4 million units IM one time for primary syphilis or weekly for 3 weeks for secondary or latent syphilis (of >1 year in duration), is the regimen of choice.
- Doxycycline, 100 mg PO bid for 14 days, is an alternative.
- If neurosyphilis is present, penicillin G, 12â??24 million units IV daily for 14 days, is the treatment of choice. Patients who are allergic to penicillin should be desensitized. Data regarding the use of ceftriaxone, 1â??2 g IV daily for 14 days, are limited.
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- Close monitoring and follow-up using the nontreponemal test at 3, 6, and 12 months are necessary in all cases.
- Persons with a sustained positive nontreponemal titer should receive retreatment and be considered for CSF evaluation to rule out neurosyphilis