This protocol applies to patients with early latent syphilis — infection acquired within the previous year — who have a documented penicillin allergy or who decline parenteral treatment.
Early latent syphilis is classified as early when acquired within the first year of infection. When penicillin allergy is present or parenteral therapy is refused, standard first-line treatment cannot be used and an alternative approach is required.
An oral antibiotic alternative is the primary option in this setting; penicillin desensitization may also be considered where resources allow. The complete regimen, monitoring schedule, and follow-up criteria are in the full protocol.
A significant decline in non-treponemal test titres (VDRL/RPR) within 6 months is the primary serological marker of treatment response.
DOI: 10.1111/jdv.16946
Rather arbitrarily classified as early if within the first year of infection and late (or undetermined duration) after ≥1 year.
Penicillin allergy or parenteral treatment refused.
Doxycycline 200 mg daily (either 100 mg twice daily or as a single 200 mg dose) orally for 14 days.
Desensitization to penicillin is an option but not possible in many settings and labour intensive.
After treatment of early syphilis, the titre of a NTT taken at day 0 (e.g. VDRL and/or RPR) should decline by ≥2 dilution steps (≥fourfold decrease in titre of antibodies) within 6 months.
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