eMedicine Specialties > Dermatology > Bacterial Infections
Endemic Syphilis: Treatment & Medication
Updated: Feb 13, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Medical Care
- Endemic syphilis responds well to penicillin and other treponemicidal drugs. Patients become noninfectious within 24 hours.
- After successful treatment, the titer of nontreponemal tests shows a gradual decline and eventually becomes negative.
- No vaccines for the disease are available.
Medication
The goals of pharmacotherapy are to eradicate the infection, to reduce morbidity, and to prevent complications.
Antibiotics
These agents have the capability to achieve a 100% cure rate. Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.
Penicillin G benzathine (Bicillin LA)
Effectively used to treat primary and secondary endemic syphilis. Tertiary endemic syphilis also responds to treatment but requires a longer time to achieve full effect.
Adult
1.2 million units IM once
Pediatric
<10 years: 50,000 U/kg IM once; not to exceed 1.2 million units/dose
>10 years: Administer as in adults
Probenecid can increase effects; coadministration of tetracyclines can decrease effects; may increase methotrexate toxicity; may decrease contraceptive efficacy; may interfere with immunological response to live typhoid vaccine; concurrent administration with aminoglycoside therapy may result in inactivation of aminoglycoside (amikacin appears to possess greatest stability in presence of penicillins; in treatment of severely ill patients requiring both penicillin and aminoglycoside therapy, amikacin is aminoglycoside of choice)
Documented hypersensitivity; patients with epilepsy (neurotoxicity is a common feature); patients predisposed to hemorrhage or those receiving anticoagulants
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Caution in impaired renal function, preexisting seizure disorder, or patients with electrolyte abnormalities (contains 1.7 mEq of potassium per million U); can cause acute renal nephritis
Tetracycline (Sumycin)
Can be used in patients allergic to penicillin. Treats gram-positive and gram-negative organisms as well as mycoplasmal, chlamydial, and rickettsial infections. Inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunits.
Adult
500 mg PO qid for 15 d
Pediatric
<8 years: Not recommended
>8 years:
Bejel and Yaws: 25-50 mg/kg/d PO divided qid for 15 d
Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; may enhance agents with neuromuscular blocking effect; can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy; tetracyclines can increase hypoprothrombinemic effects of anticoagulants
Coadministration with retinoids can cause increased intracranial pressure (coadministration contraindicated); administer tetracycline at least 1 h before or 4-6 h after colestipol or cholestyramine; if tetracycline administered concurrently with digoxin, monitor digoxin levels (dosage adjustment for digoxin may be required; risk of interaction may be reduced if given with Lanoxicaps)
Documented hypersensitivity; severe hepatic dysfunction
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Pseudotumor cerebri has been associated with tetracyclines, therefore, possibility for permanent sequelae exists; photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (last half of pregnancy through age 8 y) can cause permanent discoloration of teeth; may cause falsely positive urine glucose measurements
Erythromycin (E.E.S., E-Mycin, Ery-Tab)
Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. For treatment of staphylococcal and streptococcal infections.
In children, age, weight, and severity of infection determine proper dosage. When bid dosing is desired, half-total daily dose may be taken q12h. For more severe infections, double the dose. Can be used in child <8 y.
Adult
Erythromycin estolate: 500 mg qid for 10 d
Erythromycin ethylsuccinate: 800 mg 6 times/d or 1600 mg tid for 10 d
Erythromycin stearate: 500 mg 6 times/d for 10 d or 1000 mg tid for 10 d
Pediatric
8 mg/kg PO qid for 15 d
May significantly alter metabolism of nonsedating antihistamines and cause serious adverse cardiovascular events; concurrent use of lovastatin and erythromycin may cause rhabdomyolysis in patients who are seriously ill; may increase serum theophylline levels and toxicity; concomitant administration of digoxin may result in elevated serum digoxin levels; coadministration can increase effects of anticoagulants; concurrent use with ergotamine or dihydroergotamine has been associated with acute ergot toxicity; may decrease clearance of triazolam and midazolam; in patients taking other drugs metabolized by cytochrome P-450 system, may be associated with elevations in serum concentrations of those drugs; has demonstrated QTc prolongation in combination with other drugs that prolong the QT interval
Documented hypersensitivity; hepatic impairment; concomitant therapy with astemizole, cisapride, pimozide, or terfenadine
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Caution in liver disease; estolate formulation may cause cholestatic jaundice; GI adverse effects are common (give doses pc); discontinue use if nausea, vomiting, malaise, abdominal colic, or fever occur; neurological symptoms can be potentiated in myasthenia gravis; elderly patients may experience increased susceptibility to torsades de pointes arrhythmias
More on Endemic Syphilis |
| Overview: Endemic Syphilis |
| Differential Diagnoses & Workup: Endemic Syphilis |
 Treatment & Medication: Endemic Syphilis |
| Follow-up: Endemic Syphilis |
| References |
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References
Clyti E, dos Santos RB. [Endemic treponematoses in Maputo, Mozambique]. Bull Soc Pathol Exot. May 2007;100(2):107-8. [Medline].
Parish JL. Treponemal infections in the pediatric population. Clin Dermatol. Nov-Dec 2000;18(6):687-700. [Medline].
Sharma VK, Kumar B. Malignant syphilis or syphilis simulating malignancy. Int J Dermatol. Sep 1991;30(9):676. [Medline].
Antal GM, Lukehart SA, Meheus AZ. The endemic treponematoses. Microbes Infect. Jan 2002;4(1):83-94. [Medline].
Blount JH, Holmes KK. Epidemiology of syphilis and the non-venereal treponematoses. In: Johnson RC, ed. The Biology of Parasitic Spirochetes. New York, NY: Academic; 1976:157-76.
Cutler JC. Endemic syphilis, yaws, and pinta. In: Johnson RC, ed. The Biology of Parasitic Spirochetes. New York, NY: Academic; 1976:365-73.
Engelkens HJ, Niemel PL, van der Sluis JJ, Meheus A, Stolz E. Endemic treponematoses. Part II. Pinta and endemic syphilis. Int J Dermatol. Apr 1991;30(4):231-8. [Medline].
Falabella R. Nonvenereal treponematoses: yaws, endemic syphilis, and pinta. J Am Acad Dermatol. Dec 1994;31(6):1075. [Medline].
Farnsworth N, Rosen T. Endemic treponematosis: review and update. Clin Dermatol. May-Jun 2006;24(3):181-90. [Medline].
Kanan MW, Kandil E. Bejel or non-venereal endemic syphilis. Br J Dermatol. May 1971;84(5):461-4. [Medline].
Knox JM, Musher D, Guzick ND. The pathogenesis of syphilis and the related treponematoses. In: Johnson RC, ed. The Biology of Parasitic Spirochetes. New York, NY: Academic; 1976:249-59.
Koff AB, Rosen T. Nonvenereal treponematoses: yaws, endemic syphilis, and pinta. J Am Acad Dermatol. Oct 1993;29(4):519-35; quiz 536-8. [Medline].
Meheus A, Antal GM. The endemic treponematoses: not yet eradicated. World Health Stat Q. 1992;45(2-3):228-37. [Medline].
Morand JJ, Simon F, Garnotel E, Mahe A, Clity E, Morlain B. [Overview of endemic treponematoses]. Med Trop (Mars). Feb 2006;66(1):15-20. [Medline].
Nsanze H, Lestringant GG, Ameen AM, Lambert JM, Galadari I, Usmani MA. Serologic tests for treponematoses in the United Arab Emirates. Int J Dermatol. Nov 1996;35(11):800-1. [Medline].
Further Reading
Keywords
nonvenereal syphilis of children, sibbens, radseyege, siti, therlijevo, njovera, frenjak, Treponema pallidum subsp endemicum, T pallidum subsp endemicum, nonvenereal endemic syphilis Bejel, non-venereal endemic syphilis Bejel
