What Is the Treatment of Gummatous Tertiary Syphilis Presenting with Nodules, Plaques, or Destructive Granulomatous Lesions?
Clinical Scenario
Gummatous tertiary syphilis is a late-stage presentation in which an individual with positive syphilis serology develops characteristic nodules, plaques, or destructive granulomatous (gummatous) lesions. The diagnosis is made on clinical grounds.
Although gummatous lesions can occur at any anatomical site, the skin and bones are most commonly affected.
Treatment Approach
Management involves a structured course of antibiotic therapy. The protocol defines a first-line regimen together with several alternative options for patients who cannot receive the standard approach. The specific agents, durations, and any patient-level adaptations are set out in the full structured protocol.
Treatment Goal
Resolution of the granulomatous gummatous lesions following administration of the selected antibiotic regimen.
References
- Diagnosis of syphilitic gummata is usually made on clinical grounds: typical nodules/plaques or destructive lesions in individuals with positive syphilis serology.
- They can occur anywhere, but most often affect skin and bones.
- Benzathine penicillin 2.4 MU IM weekly for 3 weeks (three doses): 1C.
- Doxycycline 100 mg PO BD for 28 days: 2D.
- Amoxycillin 2 g PO three times daily (TDS) PLUS probenecid 500 mg QDS for 28 days: 2C.
- Ceftriaxone 2 g IM or IV for 10–14 days: 2D.
- Granulomatous lesions rapidly resolve on administration of therapy.