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Kingston M, Apea V, Evans C, Fifer H, Foster K, Patrick P, Grant A, Manns V, Ramsden S, Sinka K, Sukthankar A, Sullivan A, Tyler S. BASHH UK guidelines for the management of syphilis 2024. Int J STD AIDS 2024:9564624241280406. [PMID: 39270129 DOI: 10.1177/09564624241280406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
The 2024 UK guidelines for the management of syphilis are in line with current evidence and practice within the UK. Key updates are detailed at the start of the article. These guidelines are accompanied by the first UK guidelines for the management of syphilis in pregnant people and children, 2024.
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Affiliation(s)
- Margaret Kingston
- Consultant Physician Genitourinary Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Vanessa Apea
- Consultant Physician Genitourinary Medicine, Barts Health NHS Trust, London, UK
| | - Ceri Evans
- Senior Sexual Health Advisor, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Helen Fifer
- Consultant Microbiologist, UK Health Security Agency, Newcastle upon Tyne, UK
| | - Kirsty Foster
- Consultant in Health Protection, UK Health Security Agency, Newcastle upon Tyne, UK
| | - Patrick Patrick
- Mortimer Market Centre, Central and North West London NHS Trust, London, UK
| | - Alison Grant
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Vicky Manns
- Advanced Nurse Specialist, Churchill Hospital, Oxford, UK
| | - Sophie Ramsden
- Consultant Physician Genitourinary Medicine, Bolton NHS Foundation Trust, Bolton, UK
| | - Katy Sinka
- Consultant Scientist and Epidemiologist, UK Health Security Agency, Newcastle upon Tyne, UK
| | - Ashish Sukthankar
- Consultant Physician Genitourinary Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ann Sullivan
- BASHH Clinical Effectiveness Group (CEG) Editor, Consultant Physician Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Mehta N, Bhari N, Gupta S. Asian guidelines for syphilis. J Infect Chemother 2022; 28:1084-1091. [PMID: 35527175 DOI: 10.1016/j.jiac.2022.04.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/01/2022] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Nikhil Mehta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Neetu Bhari
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Somesh Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.
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Taylor MM, Kara EO, Araujo MAL, Silveira MF, Miranda AE, Branco Coelho IC, Bazzo ML, Mendes Pereira GF, Pereira Giozza S, Bermudez XPD, Mello MB, Habib N, Nguyen MH, Thwin SS, Broutet N. Phase II trial evaluating the clinical efficacy of cefixime for treatment of active syphilis in non-pregnant women in Brazil (CeBra). BMC Infect Dis 2020; 20:405. [PMID: 32522244 PMCID: PMC7288542 DOI: 10.1186/s12879-020-04980-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 03/17/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Syphilis is a sexually and vertically transmitted infection caused by the bacteria Treponema pallidum for which there are few proven alternatives to penicillin for treatment. For pregnant women infected with syphilis, penicillin is the only WHO-recommended treatment that will treat the mother and cross the placenta to treat the unborn infant and prevent congenital syphilis. Recent shortages, national level stockouts as well as other barriers to penicillin use call for the urgent identification of alternative therapies to treat pregnant women infected with syphilis. METHODS This prospective, randomized, non-comparative trial will enroll non-pregnant women aged 18 years and older with active syphilis, defined as a positive rapid treponemal and a positive non-treponemal RPR test with titer ≥1:16. Women will be a, domized in a 2:1 ratio to receive the oral third generation cephalosporin cefixime at a dose of 400 mg two times per day for 10 days (n = 140) or benzathine penicillin G 2.4 million units intramuscularly based on the stage of syphilis infection (n = 70). RPR titers will be collected at enrolment, and at three, six, and nine months following treatment. Participants experiencing a 4-fold (2 titer) decline by 6 months will be considered as having an adequate or curative treatment response. DISCUSSION Demonstration of efficacy of cefixime in the treatment of active syphilis in this Phase 2 trial among non-pregnant women will inform a proposed randomized controlled trial to evaluate cefixime as an alternative treatment for pregnant women with active syphilis to evaluate prevention of congenital syphilis. TRIAL REGISTRATION Trial identifier: www.Clinicaltrials.gov, NCT03752112. Registration Date: November 22, 2018.
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Affiliation(s)
- Melanie M Taylor
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
- U.S. Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, GA, USA.
| | - Edna Oliveira Kara
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | | | | | - Ivo Castelo Branco Coelho
- Federal University of Ceará, Ambulatório de IST do Hospital Universitário da Universidade Federal do Ceará, Fortaleza, Brazil
| | | | - Gerson Fernando Mendes Pereira
- Brazil Ministry of Health, Secretariat for Health Surveillance, Department of Chronic Conditions and Sexually Transmitted Infections, Brasília, Brazil
| | - Silvana Pereira Giozza
- Brazil Ministry of Health, Secretariat for Health Surveillance, Department of Chronic Conditions and Sexually Transmitted Infections, Brasília, Brazil
| | | | - Maeve B Mello
- University of Brasília, Brasília, Brazil
- Department of Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization/World Health Organization, Washington, Washington, DC, USA
| | - Ndema Habib
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - My Huong Nguyen
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Soe Soe Thwin
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Nathalie Broutet
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Kingston M, French P, Higgins S, McQuillan O, Sukthankar A, Stott C, McBrien B, Tipple C, Turner A, Sullivan AK, Radcliffe K, Cousins D, FitzGerald M, Fisher M, Grover D, Higgins S, Kingston M, Rayment M, Sullivan A. UK national guidelines on the management of syphilis 2015. Int J STD AIDS 2015; 27:421-46. [PMID: 26721608 DOI: 10.1177/0956462415624059] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 12/02/2015] [Indexed: 12/12/2022]
Abstract
These guidelines are an update for 2015 of the 2008 UK guidelines for the management of syphilis. The writing group have piloted the new BASHH guideline methodology, notably using the GRADE system for assessing evidence and making recommendations. We have made significant changes to the recommendations for screening infants born to mothers with positive syphilis serology and to facilitate accurate and timely communication between the teams caring for mother and baby we have developed a birth plan. Procaine penicillin is now an alternative, not preferred treatment, for all stages of syphilis except neurosyphilis, but the length of treatment for this is shortened. Other changes are summarised at the start of the guideline.
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Affiliation(s)
- M Kingston
- Manchester Centre for Sexual Health, Manchester, UK
| | - P French
- Mortimer Market Centre, London, UK
| | - S Higgins
- North Manchester General Hospital, Manchester, UK
| | - O McQuillan
- Manchester Centre for Sexual Health, Manchester, UK
| | - A Sukthankar
- Manchester Centre for Sexual Health, Manchester, UK
| | - C Stott
- Manchester Centre for Sexual Health, Manchester, UK
| | - B McBrien
- Manchester Centre for Sexual Health, Manchester, UK
| | - C Tipple
- Jefferiss Wing Centre for Sexual Health, Imperial College Health Care NHS Trust, London, UK
| | - A Turner
- The Public Health England/Clinical Virology Laboratory, Manchester Royal Infirmary, Manchester, UK
| | | | | | - Keith Radcliffe
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Darren Cousins
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Mark FitzGerald
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Martin Fisher
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Deepa Grover
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Stephen Higgins
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Margaret Kingston
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Michael Rayment
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
| | - Ann Sullivan
- Clinical Effectiveness Group, British Association for Sexual Health and HIV, Macclesfield, UK
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Tanizaki R, Nishijima T, Aoki T, Teruya K, Kikuchi Y, Oka S, Gatanaga H. High-dose oral amoxicillin plus probenecid is highly effective for syphilis in patients with HIV infection. Clin Infect Dis 2015; 61:177-83. [PMID: 25829004 DOI: 10.1093/cid/civ270] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 03/21/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Intramuscular benzathine penicillin G (BPG) is widely used for the treatment of syphilis. However, BPG is not available in some countries. This study examined the effectiveness and safety of high-dose oral amoxicillin plus probenecid for the treatment of syphilis in patients with human immunodeficiency virus type 1 (HIV-1). METHODS This retrospective observational study included 286 HIV-infected male patients with syphilis (median age, 36 years; median CD4 count, 389 cells/µL) who were treated with oral amoxicillin 3 g plus probenecid. Syphilis was diagnosed by both serum rapid plasma reagin (RPR) titers ≥8 and positive Treponema pallidum hemagglutination test. Patients with neurosyphilis diagnosed by cerebrospinal fluid examination were excluded. Successful treatment was defined as a at least 4-fold decrement in RPR titer. RESULTS The overall treatment efficacy was 95.5% (95% confidence interval [CI], 92.4%-97.7%; 273/286 patients), and efficacy for primary, secondary, early latent, late latent, and unknown duration syphilis was 93.8% (95% CI, 68.1%-99.8%; 15/16), 97.3% (95% CI, 92.9%-99.2%; 142/146), 100% (95% CI, 90.5%-100%; 37/37), 85.7% (95% CI, 58.6%-96.4%; 18/21), and 92.4% (95% CI, 81.9%-97.3%; 61/66), respectively. Treatment duration was mostly 14-16 days (49.7%) or 28-30 days (34.3%), with efficacy of 94.4% (134/142) and 95.9% (94/98), respectively; 96.3% of successfully treated patients achieved a ≥4-fold decrement in RPR titer within 12 months. Adverse events were noted in 28 (9.8%) patients, and 25 of these (89.3%) were successfully treated. Only 6% of patients underwent lumbar puncture. CONCLUSIONS The combination of oral amoxicillin 3 g plus probenecid was highly effective and tolerable for the treatment of syphilis in patients with HIV-1 infection.
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Affiliation(s)
- Ryutaro Tanizaki
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo
| | - Takeshi Nishijima
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo Center for AIDS Research, Kumamoto University, Japan
| | - Takahiro Aoki
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo
| | - Katsuji Teruya
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo
| | - Yoshimi Kikuchi
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo
| | - Shinichi Oka
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo Center for AIDS Research, Kumamoto University, Japan
| | - Hiroyuki Gatanaga
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo Center for AIDS Research, Kumamoto University, Japan
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Goldmeier D, Hay P. A review and update on adult syphilis, with particular reference to its treatment. Int J STD AIDS 1993; 4:70-82. [PMID: 8476969 DOI: 10.1177/095646249300400203] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Syphilis has become less common in Europe in the last decade, but has once again become a major problem in the USA, and remains so in many developing countries. Several treponemal genes have now been cloned and expressed in Escherichia coli, allowing study of treponemal proteins. The importance of cell mediated immunity in syphilis has been demonstrated in animal models. A diagnosis of syphilis is usually confirmed by dark-field microscopy or serological tests. Seroconversion may be delayed in HIV infected individuals. A positive reaginic test in cerebrospinal fluid (CSF) has a high specificity but low sensitivity in the diagnosis of neurosyphilis. Indeed, virulent treponemes can be identified in CSF samples which have negative reaginic tests, normal cell counts and protein levels. In the CSF, the FTA-Abs test has a high sensitivity but low specificity for neurosyphilis. Penicillin remains the treatment of choice for all stages of syphilis, although it penetrates the blood brain barrier poorly. Treatment with intramuscular benzathine penicillin 2.4 million units stat, or 600,000 units procaine penicillin daily does not produce treponemicidal levels within the CSF. However, the incidence of neurosyphilis is low in immunocompetent patients treated with such regimens during early syphilis. Acceptable alternatives in penicillin-allergic patients include ceftriaxone and doxycycline. Erythromycin is not recommended as it has produced unacceptably high rates of treatment failure. Recently, a strain of macrolide-resistant Treponema pallidum was isolated from a patient with secondary syphilis. For the treatment of neurosyphilis, treponemicidal levels of penicillin can be achieved in the CSF using 2.4 million units procaine penicillin daily with concurrent probenecid 500 mg 4 times a day, or an intravenous infusion of benzyl penicillin 12-24 million units daily. Early syphilis can be treated adequately over 10 days, but 21 to 28 days is appropriate for late syphilis. In HIV-infected patients syphilis may present atypically with initially negative serological tests. Treatment of early syphilis in HIV-positive patients has been associated with the early development of neurosyphilis. It is advisable to treat all patients co-infected with HIV with an antibiotic regimen that achieves adequate levels within the CSF.
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Affiliation(s)
- E W Hook
- Johns Hopkins University School of Medicine, Baltimore
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Frentz G, Nielsen PB, Espersen F, Czartoryski A, Aastrup H. Penicillin concentrations in blood and spinal fluid after a single intramuscular injection of penicillin G benzathine. EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY 1984; 3:147-9. [PMID: 6723638 DOI: 10.1007/bf02014334] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The concentration of penicillin in cerebrospinal fluid and blood was measured after a single i.m. injection of 1.44 g penicillin G benzathine in 18 individuals (4 with neurosyphilis and 14 with neurological symptoms but not syphilis). Only one person had a treponemicidal concentration in the cerebrospinal fluid.
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