{ "schema_version": 1, "kind": "condition", "id": "syphilis", "name": "Syphilis (Primary, Secondary & Early Latent)", "category": "infectious", "sources": "CDC STI Treatment Guidelines 2021 · WHO Guidelines for the Treatment of Treponema pallidum 2016 · BASHH UK national guidelines for the management of syphilis 2024 · Syphilis - disease-level clinical article (syphilis-full.txt)", "review_status": "reviewed", "verified_against": "BASHH UK national guidelines for the management of syphilis 2024 · Syphilis - disease-level clinical article (syphilis-clinical.txt) · Syphilis - disease-level clinical article (syphilis-full.txt)", "verified_date": "2026-08", "treatments": [ { "id": 1749, "generic": "Benzathine benzylpenicillin", "line": 1, "is_adjunct": false, "form": "injection", "strength_mg": null, "adult_dose": "2.4 million units IM as a single dose (administered as two 1.2 million unit injections in separate gluteal sites)", "adult_duration": "Single dose", "dose_source": "BASHH UK national guidelines for the management of syphilis 2024", "rationale": "Long-acting depot penicillin that maintains sustained treponemicidal blood levels after intramuscular injection, matching the slow replication cycle of Treponema pallidum; the standard treatment for early syphilis.", "cautions": [ "MUST be administered INTRAMUSCULARLY ONLY; accidental IV administration can cause cardiac arrest and death.", "Warn patient about Jarisch-Herxheimer reaction (fever, chills, headache, tachycardia) starting within 2-12 hours after injection.", "Perform baseline quantitative non-treponemal serology (VDRL/RPR) and repeat at 6 and 12 months to confirm cure." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Children with early acquired syphilis: 50,000 units/kg IM single dose (max 2.4 million units). Congenital syphilis requires IV aqueous crystalline penicillin G in a specialist pediatric unit.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "HAYA BENZ-R 1.2 M.I.U. VIAL FOR I.M INJ.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEDICO > HAYA PHARM-EGYPT", "price_egp": 5.06, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PENICID LA 1 200 000 UNITS VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 6.5, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BENZACILLIN 1.2 M.I.U.FOR I.M.INJ VIAL.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NASR", "price_egp": 7.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RETARPEN 1.2 M.I.U. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANDOZ > OCTOBER PHARMA", "price_egp": 10.5, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LASTIPEN 1 200 000 IU VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR", "price_egp": 12.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BENZABIOTIC 1.2 M.I.U. I.M. VIAL.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEDICO", "price_egp": 16.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DEPO-PEN 1.2 MIU VIAL.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 25.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PENCILONG (PENCITARD) 1200000 I.U./VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "NCPC NORTH BEST CO > ACDIMA INTERNATIONAL TRADING", "price_egp": 25.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "syphilis" }, { "id": 1751, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Syphilis - disease-level clinical article (syphilis-clinical.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - Doxycycline (and the tetracyclines) must not be used to treat syphilis in pregnancy. There is no proven penicillin alternative in pregnancy; penicillin-allergic pregnant patients need skin testing/desensitization instead.", "RED FLAG - The Jarisch-Herxheimer reaction (fever, headache, myalgia, rash within hours of the first antibiotic dose) can follow the first treatment dose; in pregnancy it carries a higher risk of obstetric complications." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "syphilis" }, { "id": 1750, "generic": "Doxycycline", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 100.0, "adult_dose": "100 mg twice daily", "adult_duration": "14 days", "dose_source": "BASHH UK national guidelines for the management of syphilis 2024", "rationale": "Doxycycline 100 mg BID for 14 days is the primary alternative for non-pregnant adults with penicillin allergy. Pregnant patients with penicillin allergy MUST undergo penicillin desensitization.", "cautions": [ "Pregnant women with syphilis who are allergic to penicillin MUST be desensitized and treated with benzathine penicillin G; doxycycline is contraindicated.", "Requires rigorous serological follow-up at 3, 6, 9, and 12 months." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Contraindicated in children under 8 years. A penicillin-allergic child with syphilis needs specialist desensitisation, or a specialist opinion on the alternatives. The Egyptian National Drug Formulary - Antimicrobial 2023, doxycycline monograph, gives the reason: used while the teeth are still forming - the second half of pregnancy, infancy, and childhood up to 8 years - it can stain the teeth permanently, leave the enamel underformed, or discolour tissue, and although long courses carry more of this risk, repeated short courses have done it too.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "FARCODOXIN 100MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 11.0, "pack_count": 10, "unit_price": 1.1, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DOXY M.R.100 MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ADWIA", "price_egp": 12.0, "pack_count": 10, "unit_price": 1.2, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GRANUDOXY 100MG 10 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS > PIERRE FRANCE", "price_egp": 12.0, "pack_count": 10, "unit_price": 1.2, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DOXYDOX 100 MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 23.0, "pack_count": 10, "unit_price": 2.3, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DOXYMYCIN 100 MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE.", "price_egp": 30.0, "pack_count": 10, "unit_price": 3.0, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TABOCINE 100MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA", "price_egp": 46.0, "pack_count": 10, "unit_price": 4.6, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VIBRAMYCIN 100MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PFIZER", "price_egp": 65.0, "pack_count": 10, "unit_price": 6.5, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "syphilis" }, { "id": 1752, "generic": "Ceftriaxone", "line": 2, "is_adjunct": false, "form": "injection", "strength_mg": 1000.0, "adult_dose": "1 to 2 g IM or IV once daily", "adult_duration": "10 to 14 days", "dose_source": "Syphilis - disease-level clinical article (syphilis-full.txt)", "rationale": "An earlier review refused this because MSF's ceftriaxone monograph names neurosyphilis and no course length. Re-opened under the two-claims rule: the condition's own article carries both claims. Indication - the article reports that the CDC, the European guidelines and the WHO all accept ceftriaxone as a reasonable alternative to penicillin in syphilis, where a shortage, a severe allergic reaction, a refusal or some comparable reason rules penicillin out. Dose - the alternatives it lists are doxycycline at 100 mg orally, twice a day for 14 days; ceftriaxone given intramuscularly or intravenously at 1 to 2 g daily, for 10 to 14 days; and tetracycline, 100 mg orally, 4 times a day across 14 days. Benzathine penicillin remains first line and doxycycline remains the oral penicillin-allergy option.", "cautions": [ "MSF's ceftriaxone monograph names only the late form of the disease in its indications - its list is of severe bacterial infection: septicaemia and meningitis, pneumonia, typhoid, shigellosis, leptospirosis, pyelonephritis, the tick-borne relapsing fevers and neurosyphilis among them. The early-syphilis indication and the 10-to-14-day course both come from the disease article.", "PREGNANCY - the article is explicit that this is not a substitute. Nothing else has been shown to be an acceptable alternative to penicillin for syphilis in pregnancy. The pregnant woman who reports penicillin allergy is therefore skin tested to establish what her real risk is, and desensitised so that penicillin can be given.", "The same article states both sides of the pregnancy question and both are printed here: doxycycline and the tetracyclines in particular are to be avoided in the later stages of pregnancy, and there is too little data on ceftriaxone and the cephalosporins for them to be used - yet where an alternative drug is genuinely unavoidable, ceftriaxone is the one it suggests (Syphilis - StatPearls - NCBI Bookshelf, NBK534780).", "Most reported penicillin allergy is not allergy. Confirm it before abandoning benzathine penicillin, which is the proven treatment.", "A Jarisch-Herxheimer reaction may follow the first dose of any effective treponemal treatment - warn the patient." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "No paediatric syphilis regimen is stated in the documents held here. MSF gives ceftriaxone 50 to 100 mg/kg once daily for severe bacterial infection generally, which is not a syphilis regimen.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "ZOXIDEL 1 GM PD. FOR I.M. INJ.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > DELTA PHARMA", "price_egp": 22.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CEFTRIAXONE SODIUM 1 GM I.M.VIAL (KAHIRA)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 29.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ZOXIDEL 1 GM PD. FOR I.V. INJ.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > DELTA PHARMA", "price_egp": 29.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "WINTRIAXONE 1 GM PD. FOR I.V INJ.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 48.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VOTRIAXONE 1 GM I.M VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CHEMIPHARM", "price_egp": 56.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "OFRAMAX 1 GM I.M. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > SUN PHARMA EGYPT LIMITED", "price_egp": 71.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TRIAXONE 1 GM I.M. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA", "price_egp": 106.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TRIAXONE 1 GM I.V VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA", "price_egp": 106.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "syphilis" } ] }