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Syphilis and Penicilin allergy
Sep 12, 2017

Hi Doctor,

I have been contacted by someone with whom I had sex some days ago, explaining me that he has been diagnosed with syphilis. If I am not mistaken, the treatment for this condition is penicilin. However, I am highly allergic to penicilin. Is there any other option? Do we have any PEP for syphilis which would not involve any penicilin?

Thank you for your help

Response from Dr. Young

Hello and thanks for posting.

Syphilis infection is unfortunately common among people living with HIV and populations of people at risk for HIV infection- indeed, new cases of syphilis are increasing in many communities. For this reason, screening for syphilis is widely recommended. The US Centers for Disease Control (CDC) recommends that for "sexually active individuals, screen at first HIV evaluation, and at least annually thereafter and more frequent screening for might be appropriate depending on individual risk behaviors and the local epidemiology."

Importantly, anyone who had sex with a person who received a diagnosis of syphilis (within 90 days preceding the diagnosis) should be treated presumptively for early syphilis, even if blood-based test results are negative.

The preferred treatment for syphilis is penicillin G intramuscular injection(s) (not oral formulations of penicillin). For people with documented penicillin allergy can be treated with alternative medications, though the data to support use of alternatives to penicillin in the treatment of primary and secondary syphilis are limited. Among non-pregnant, penicillin-allergic persons who have primary or secondary syphilis, the CDC recommends regimens of doxycycline 100 mg orally twice daily for 14 days and tetracycline (500 mg four times daily for 14 days) have been used for many years. Some doctors will use ceftriaxone intramuscular or intravenous injections as an alternative.

For more information about syphilis diagnostics and treatment, check out this page from the CDC.

I hope that's helpful, BY

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