Update 2006: The CDC's STD Guidelines
New challenges, new recommendations.
Syphilis is on the rise in the United States. Each year, 19 million cases of sexually transmitted diseases (STDs) occur in the U.S.10 To meet this major public health challenge, the Centers for Disease Control and Prevention (CDC) employs a scientific, evidence-based process to regularly update its STD treatment guidelines.7 This comprehensive document addresses the wide range of STDs likely to be encountered by clinicians in the U.S.7 The CDC web site offers a free copy of the CDC STD treatment guidelines for 2006.
Penicillin G benzathine, a first-line treatment for syphilis: highlights of the 2006 CDC guidelines
- A first-line treatment in adults: Penicillin G benzathine is the recommended treatment for primary, secondary, latent, and tertiary syphilis (with the exception of neurosyphilis and syphilitic eye disease).7
- A first-line treatment for infants (>1 month) and children: For primary, secondary, and latent infection, the CDC recommends penicillin G benzathine.7
- Neurosyphilis and syphilitic eye disease in adults: For these disease manifestations in adults, the CDC recommends aqueous crystalline penicillin or procaine penicillin plus probenecid.7
- Treatment of penicillin-allergic patients: Data to support use of alternatives to penicillin in the treatment of primary, secondary, and latent syphilis are limited.7 The CDC guidelines list alternative options, including doxycycline, macrolides, and ceftriaxone.7 The report notes uncertainty regarding optimal dose and duration of therapy with ceftriaxone (to which penicillin-allergic patients may also react) and cites recently documented resistance to azithromycin as reasons to closely follow any patient in whom these alternative therapies are used.6,13
- Treatment in pregnancy: The CDC advocates desensitization and treatment with penicillin in all pregnant, penicillin-allergic patients.7
Learn about the dosing and administration of BICILLIN® L-A.
Notifying sexual contacts
- Sexual transmission of syphilis occurs when one partner has a mucocutaneous syphilitic lesion. However, all sexual partners of patients with syphilis at any stage need to be notified so they can be tested and, if necessary, treated for infection.7
- The CDC recommends the following diagnostic and treatment protocols:7
- Exposure history: Persons exposed ≤90 days before the diagnosis of primary, secondary, or early latent syphilis in a sex partner should be treated presumptively. After 90 days, they should be treated presumptively if serologic test results are not available immediately and the opportunity for follow-up is uncertain.
- Role of serology: "For purposes of partner notification and presumptive treatment of exposed sex partners, patients with syphilis of unknown duration who have high nontreponemal serologic test titers (i.e., ≥1:32) can be assumed to have early syphilis. However, serologic titers should not be used to differentiate early from late latent syphilis for the purpose of determining treatment."6, p.24
- Partners of those with latent disease: "Long-term sex partners of patients who have latent syphilis should be evaluated clinically and serologically for syphilis and treated on the basis of the evaluation findings."6, p.24
- To identify at-risk sexual partners, "the periods before treatment of the index patient are:7
- 3 months plus duration of symptoms for primary syphilis
- 6 months plus duration of symptoms for secondary syphilis
- 1 year for early latent syphilis"6, p.24
Follow-up
No treatment for syphilis can be assumed to be effective 100 percent of the time. Assessing response to treatment may be difficult, and unequivocal criteria for cure have not been established. Patients should be reexamined both clinically and serologically 6 and 12 months after treatment. When follow-up is uncertain, the CDC suggests that more frequent evaluation might be prudent.7
For more information, see the CDC STD treatment guidelines for 2006.
Relevant links 
Learn about the dosing and administration of BICILLIN® L-A.
Get a copy of the full CDC STD treatment guidelines for 2006.
Note: BICILLIN® L-A is indicated for syphilis. BICILLIN® C-R is not.2,3 Learn about BICILLIN® C-R (penicillin G benzathine and penicillin G procaine injectable suspension).
