Treatment of Tertiary Syphilis with Gummatous Nodules, Plaques or Ulcers of Skin and Mucosae

This protocol covers tertiary syphilis presenting as gummatous syphilis — with nodular, plaque-like or ulcerative lesions of the skin, mucous membranes or viscera — and cardiovascular syphilis, in patients without penicillin allergy.

Clinical scenario

Gummatous syphilis manifests as nodules, plaques or ulcers affecting the skin, mucosae or visceral organs. Cardiovascular syphilis — presenting with aortic regurgitation, stenosis of coronary ostia, or aortic aneurysm (predominantly thoracic) — represents a distinct and serious manifestation of tertiary disease. Both presentations are covered by this protocol when no penicillin allergy is present.

Gummatous syphilis Cardiovascular syphilis No penicillin allergy First-line

Treatment approach

Management is based on an intramuscular penicillin antibiotic regimen. The full protocol specifies the agent, schedule and duration — access it below.

Full dosing regimen and clinical guidance available in the structured protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1111/jdv.16946

Gummatous syphilis: nodules/plaques or ulcers (skin, mucosae, visceral);

Cardiovascular syphilis: aortic regurgitation, stenosis of coronary ostia, aortic aneurysm (mainly thoracic).

Procaine penicillin 600 000 units IM daily for 17–21 days, i.e. if BPG is not available

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