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Syphilis Treatment-Penicillin Allergy
Apr 13, 2008

I have recently tested positive for Syphillis - probably contracted in the past 6 - 8 months. I am also HIV+ for about 18 years. Otherwise healthy and doing well on meds with CD4 >600. For the longest time, I have been telling medical staff that I am allergic to penicillin and sulfa drugs. Although I have a clear memory of the allergic reaction I had to Bactrim- rash fever chills... no doubt an allergic reaction - I honestly don't remember when I had such a reaction to penicillin. I know I was given it when I was a kid. But somewhere along the line, I don't remember exactly when, I started telling people I was allergic to penicillin. Maybe it coincided with the Bactirm experience 15-20 years ago. I just don't remember. So now that I need treatment for Syphilis, my Dr wants to desensitize me to penicillin, do a tap-line and hook me up to a portable pump for 2 weeks of steady low-dose penicillin, recommended for patients with penicillin allergy. I asked if before we take that route, we confirm that I truly am allergic to penicillin. He said it was too risky considering the large amount of penicillin that's given to treat Syph to non-allergic patients. Even if the scratch-test for penicillin allergy shows no reaction, the chance that there is a latent reaction is too great. So 2 questions... 1) Can a scratch-test be relied on to confirm or not a penicillin allergy and if no reaction, is it safe to proceed with normal treatment for Syph? 2) Are there alternate antibiotics that can affectively treat Syph? If I have to go the tap-line, desensitization, pump route, I will. But just want to explore any other options available. thank you very much for your time.

Response from Dr. Henry

The scratch test is of some clinical benefit in this setting. Even with a negative scratch test if the history for pen allergy is strong then a desensitization procedure may be advisable. If the history for pen allergy is weak and there is a negative scratch test then proceding with use of penicillin under observation is an option. I generally would recommend desensitization if uncertain. Pencillin is the gold standard for syphilis treatment. Data with a tetracycline or ceftriaxone suggests a higher failure rate than with penicillin. KH

thank you
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