Treatment and Therapy of syphilis

       In the treatment and therapy of syphilis should not be forgotten that their sexual partners are also treated, and as long as the patient has not recovered copulate prohibited. Treatment is started as early as possible, the earlier the better result. In latent syphilis therapy intended to prevent further processing.

Treatment using penicillin and other antibiotics.
1 Penicillin
     Drugs are a choice is penicillin. The drug can penetrate the placenta, thus preventing infection of the fetus, and can cure an infected fetus; also effective for neurosyphilis.
High levels in the serum is not required, provided that not less than 0.03 units / ml. What is important is the level should persist in the serum for ten to fourteen days for early and late syphilis, twenty-one days for neurosyphilis and cardiovascular syphilis. If the level is less than that number, after more than twenty-four to thirty hours, the bacteria can multiply.
According longer works, there are three kinds of penicillin:
a. Penicillin G procaine in aqua with long working twenty-four hours, so the work is short.
b. Procaine penicillin G in oil with aluminum monostearate (PAM), long working seventy-two hours, nature of work is.
c. Benzathine penicillin G at a dose of 2.4 units juts will last in the serum of two to three weeks, so it is a long job.
All three drugs were given intramuscularly. Derivatives penicillin by mouth is not recommended due to absorption by cerma channel is less than the injections.
The mode of administration of penicillin in accordance with their respective work longer; The first is given every day, every three days the second, and the third is usually every week.

     Penicillin G benzathine because it is a long work, make drug levels in serum can last longer and be more practical, because the patient does not need to be injected every day as the administration of penicillin G procaine in aqua. These drugs have shortcomings, which are not recommended for neurosyphilis because it is difficult to get into the blood in the brain, so it is recommended penicillin G procaine in aqua. Because penicillin G benzathine give pain at the injection site, there are investigators who do not advocate the gift to the baby. Similarly PAM gives pain at the injection site and may lead to an abscess if the injection is less deep; This drug is now rarely used.

      At the recommended therapeutic cardiovascular syphilis with penicillin G benzathine was 9.6 million units, administered 3 times the 2.4 million units, with an interval of a week. The recommended treatment for neurosyphilis is penicillin G procaine in Akua 18-24 million units daily, given 3-4 million units, iv every 4 hours for 10-14 days.

      In congenital syphilis, therapy is penicillin G procaine his advice in Akua 100,000-150,000 units / kg per day, were given 50,000 units / kg, im, every day for 10 days.

Jarish-Herxheimer reaction
        In the treatment of syphilis with penicillin may occur Jarish-Herxheimer reaction. Definite cause of this reaction is not known, it may be caused by hypersensitivity caused by toxins released by many T. paffidum the coati. Found as many as 50-80% in early syphilis. In early syphilis may occur after six to twelve hours due to the first injection of penicillin.

      Symptoms may be general and local. Common symptoms are usually mild only a slight fever. Moreover, it can also be severe: high fever, headache, arthralgia, malese, sweating, and redness of the face. The primary effect of the local symptoms become swollen due to edema and cellular infiltration, can be somewhat painful. The reaction usually disappears after ten to two hours without harming the patient betas on S I.

      In syphilis can further endanger the lives of patients, for instance: the glottis edema in patients with guma in the larynx, narrowing of the coronary artery at its origin due to edema and infiltration, and cerebral thrombosis. In addition, aneurisms can rupture or rupture of the aortic wall that has thinned due to excessive formation of fibrotic tissue due to rapid healing.
Jarish-Herxheimer reaction to treatment is with corticosteroids, for example with prednisone 20-40 mg daily. The drug can also be used as a preventative, for example in advanced syphilis, especially in disorders of the aorta and given two to three days before penicillin and continued two to three days later.

      In addition to penicillin, there are few antibiotics that can be used as a treatment for syphilis, although not as effective as penicillin. For those who are allergic to penicillin are given tetracycline 4 x 500 mg / day, or aeritromisin 4 x 500 mg / hri, or doxycycline 2 x 100 mg / day. Duration of treatment 15 days for SI and S II and 30 days for the latent stage. Erythromycin for pregnant, doubted its effectiveness. Doxycycline absorption better than tetracycline, ie, 90-100%, whereas only 60-80% tetracycline.
       In a recent study it was found that doxycycline or erythromycin given as primary syphilis therapy for 14 days, showed improvement. Other drugs are cephalosporins, such as cephalexin 4 x 500 mg daily for 15 days. Also ceftriaxone 2 g daily, a single dose of im or i.v. for 15 days.

       Azithromycin may also be used for SI and S 11, especially in the countries that are developing to replace penicillin. The dose of 500 mg daily as a single dose. Duration of treatment 10 days. According to reports Verdun et al. Recovery reached 84.4%. single. Duration of treatment 10 days. According to reports Verdun et al., Achieving 84.4% recovery.

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