This is a first-line management protocol for secondary syphilis (early syphilis), covering both the preferred therapeutic approach and available alternative regimens.
First-line management centres on a single-dose injectable antibiotic regimen. Several alternative antibiotic regimens — including both oral and injectable options — are available for patients where the preferred approach is not suitable.
The full protocol specifies all regimen options, selection criteria, and clinical decision points — accessible via the link below.
The primary serological target is a 4-fold drop in the non-treponemal (RPR) titre following treatment. Clinical and serological (RPR) follow-up is recommended at 3, 6, and 12 months.
Early syphilis (primary, secondary and early latent)
Benzathine penicillin G 2.4 MU IM single dose: 1B.
Alternative regimens: Procaine penicillin G 600,000 units IM OD for 10 days: 1C. Doxycycline 100 mg PO BD for 14 days: 1C. Ceftriaxone 500 mg–1 g IM or IV OD for 10 days (if no anaphylaxis to penicillin): 1C. Amoxycillin 500 mg PO QDS PLUS probenecid 500 mg QDS for 14 days: 1C.
It may take a number of months for the non-treponemal titres to drop 4-fold following treatment, particularly following treatment of re-infection.
Clinical and serological (RPR tests) follow-up is recommended at 3, 6 and 12 months then, if indicated, six monthly until RPR negative or serofast.
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