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Treponematosis (Endemic Syphilis): Treatment & Medication
Updated: Apr 30, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
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Treatment
Medical Care
Treatment of treponematosis is based on single-dose antibiotic therapy with benzathine penicillin.
- Treponemes are highly sensitive to penicillin, which remains the drug of choice.
- Yaws, pinta, and endemic syphilis are treated with benzathine penicillin G. Children younger than 10 years should receive 600,000 U intramuscularly, and children older than 10 years should receive 1.2 million U intramuscularly.
- Alternatives are appropriate only if benzathine penicillins cannot be used. Tetracycline (25 mg/kg/d for 10-14 d) and chloramphenicol (25 mg/kg/d for 10-14 d) have been used successfully, as has a 10-day course of doxycycline. Other penicillins, cephalosporins, and macrolides are probably active against the treponemes; however, quinolones, aminoglycosides, and sulfa antibiotics are ineffective.
- Treatment failures with penicillin have been reported,3 but reinfection could not be ruled out.
- Other important measures from the perspective of the individual patient and for public health include avoiding contact to others with cutaneous lesions and careful follow-up care to identify and to re-treat initial treatment failures.
Medication
The goals of pharmacotherapy are to eradicate the infection, to reduce morbidity, and to prevent complications.
Antibiotics
Treponemes are highly sensitive to penicillin, which remains the DOC. Yaws, pinta, and endemic syphilis are treated with 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.
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.
Adult
1.2 million U IM once
Pediatric
<10 years: 600,000 U IM once
>10 years: Administer as in adults
Probenecid can increase penicillin effectiveness by decreasing clearance; coadministration with tetracyclines can decrease effectiveness of penicillin
Documented hypersensitivity
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
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).
Adult
25 mg/kg/d PO for 10-14 d
Pediatric
<8 years: Not recommended
>8 years: Not established
Bioavailability minimally decreased with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; can decrease effects of oral contraceptives; can increase hypoprothrombinemic effects of anticoagulants
Documented hypersensitivity; severe hepatic dysfunction
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Rarely, photosensitivity may occur; use during tooth development (last half of pregnancy through age 8 y) can cause permanent discoloration of teeth
Doxycycline (Vibramycin)
Inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria.
Adult
200 mg PO on day 1, then 100 mg/d PO days 2-10
Pediatric
<8 years: Not recommended
>8 years: Not established
Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; tetracyclines can increase hypoprothrombinemic effects of anticoagulants; tetracyclines can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy; doxycycline levels are reduced significantly by carbamazepine, diphenylhydantoin, and barbiturates
Documented hypersensitivity; severe hepatic dysfunction
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
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; Fanconilike syndrome may occur with outdated tetracyclines
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.
Adult
25 mg/kg/d PO/IV for 10-14 d
Pediatric
Administer as in adults
Concurrently with barbiturates, chloramphenicol serum levels may decrease, while barbiturate levels may increase causing toxicity; manifestations of hypoglycemia may occur with sulfonylureas; rifampin may reduce serum chloramphenicol levels, presumably through hepatic enzyme induction; may increase effects of anticoagulants; may increase serum hydantoin levels, possibly resulting in toxicity; increases toxicity of cyclophosphamide
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Serious and fatal blood dyscrasias (aplastic anemia [occurs in 1 per 25,000-40,000 patients], hypoplastic anemia, thrombocytopenia, granulocytopenia) commonly occur; evaluate baseline and perform periodic blood studies approximately every 2 d while in therapy; discontinue upon appearance of reticulocytopenia, leukopenia, thrombocytopenia, anemia or findings attributable to chloramphenicol; adjust dose in liver or kidney dysfunction; caution in pregnancy at term or during labor because of potential toxic effects on fetus (gray baby syndrome characterized by abdominal distension, vomiting, flaccidity, cyanosis, circulatory collapse, and death); optic neuritis with prolonged use and a variety of hypersensitivity reactions have been described including a Herxheimerlike response during therapy for syphilis
More on Treponematosis (Endemic Syphilis) |
| Overview: Treponematosis (Endemic Syphilis) |
| Differential Diagnoses & Workup: Treponematosis (Endemic Syphilis) |
 Treatment & Medication: Treponematosis (Endemic Syphilis) |
| Follow-up: Treponematosis (Endemic Syphilis) |
| Multimedia: Treponematosis (Endemic Syphilis) |
| References |
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References
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Perine PL, Hopkins DR, Niemel PLA. Handbook of Endemic Treponematoses: Yaws, Endemic Syphilis, and Pinta. WHO Publications Centre, USA: World Health Organization; 1984.
Second International Conference on Control of Yaws. Report of Second International Conference on Control of Yaws: Nigeria, 1955. II. J Trop Med Hyg. Mar 1957;60(3):62-73. [Medline].
Vabres P, Roose B, Berdah S. [Bejel: an unusual cause of stomatitis in the child]. Ann Dermatol Venereol. Jan 1999;126(1):49-50. [Medline].
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World Health Organization. 1998 World Health Report: Health in the 21st Century: A Vision for All. 1998.
World Health Organization. WHO Expert Committee on Venereal Infections. Report on the third session. Vol 13. 1950.
Further Reading
Keywords
treponematosis, endemic syphilis, treponemiasis, nonvenereal syphilis, yaws, pinta, non-venereal syphilis, pian, bouba, frambesia, bejel, sibbens, radesyge, dichuchwa, njovera, skerljevoj, mal de pinto, carate, azul, purupuru, Treponema pallidum, Treponema pertenue, Treponema endemicum, Treponema carateum, T pallidum, T pertenue, T endemicum, T carateum
