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Treponematosis (Endemic Syphilis) Medication

  • Author: Steven Fine, MD, PhD; Chief Editor: Mark R Wallace, MD, FACP, FIDSA  more...
 
Updated: Sep 25, 2015
 

Medication Summary

The goals of pharmacotherapy are to eradicate the infection, to reduce morbidity, and to prevent complications.

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Antibiotics

Class Summary

Treponemes are highly sensitive to azithromycin and penicillin, which remain the drugs of choice. Yaws, pinta, and endemic syphilis are treated with azithromycin or penicillin G benzathine. Alternatives are appropriate only if penicillin cannot be used. Tetracyclines or chloramphenicol have been used. Treatment failures with penicillin have been reported, but reinfection could not be ruled out.

Azithromycin (Zithromax, Zmax)

 

Azithromycin acts by binding to the 50S ribosomal subunit of susceptible microorganisms and blocks dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Nucleic acid synthesis is not affected.

Azithromycin concentrates in phagocytes and fibroblasts as demonstrated by in vitro incubation techniques. In vivo studies suggest that concentration in phagocytes may contribute to drug distribution to inflamed tissues. This drug is used to treat mild-to-moderate microbial infections.

Penicillin G benzathine (Bicillin-LA)

 

Interferes with synthesis of cell wall mucopeptides during active multiplication, which results in bactericidal activity. Combination of 1 M penicillin and 2 M ammonium base. Repository form providing tissue depot from which the drug is absorbed over days. Must be administered IM and provides detectable serum levels for 15-30 d.

Tetracycline (Sumycin)

 

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 subunit(s).

Doxycycline (Vibramycin)

 

Inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria.

Chloramphenicol (Chloromycetin)

 

Binds to 50S bacterial-ribosomal subunits and inhibits bacterial growth by inhibiting protein synthesis. Effective against gram-negative and gram-positive bacteria. Well-absorbed from GI tract and metabolized in the liver, where it is inactivated by conjugation with glucuronic acid and then excreted by the kidneys.

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Contributor Information and Disclosures
Author

Steven Fine, MD, PhD Associate Professor, Department of Internal Medicine, Division of Infectious Diseases, University of Rochester School of Medicine

Steven Fine, MD, PhD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

Lynn S Fine, PhD, MPH Manager of Clinical Microbiology Laboratory, ACM Medical Laboratories; Adjunct Professor, Department of Biology, St John Fisher College and Nazareth College

Lynn S Fine, PhD, MPH is a member of the following medical societies: American Public Health Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

John L Brusch, MD, FACP Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance

John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Mark R Wallace, MD, FACP, FIDSA Clinical Professor of Medicine, Florida State University College of Medicine; Clinical Professor of Medicine, University of Central Florida College of Medicine

Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, Florida Infectious Diseases Society

Disclosure: Nothing to disclose.

Additional Contributors

Jeffrey M Zaks, MD Clinical Associate Professor of Medicine, Wayne State University School of Medicine; Vice President, Medical Affairs, Chief Medical Officer, Department of Internal Medicine, Providence Hospital

Jeffrey M Zaks, MD is a member of the following medical societies: American College of Cardiology, American College of Healthcare Executives, American Association for Physician Leadership, American Medical Association

Disclosure: Nothing to disclose.

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Nigerian boy with ulcerative skin lesions characteristic of yaws. Courtesy of the CDC/Dr. Lyle Conrad.
Photomicrograph (540X) of Treponema carateum obtained from an early pinta lesion. Courtesy of the CDC.
 
 
 
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