Syphilis Treatment: Systematic Review and Meta-Analysis Investigating Nonpenicillin Therapeutic Strategies
Penicillin G Benzathine is the universally recognized treatment for syphilis all over the world. Its reliance in eradicating Treponema pallidum is the reason why there has been shortages of Pen G Benzathine everywhere. The United States faced a shortage of the drug up until June of 2024. There are also syphilis patients who are severely allergic to penicillin who need treatment as well. This study looks at penicillin alternatives that can be just as effective in treating non-neurological syphilis as penicillin is.
The authors of this study did a systematic review and meta-analysis that looked at 27 articles that had 6,710 syphilis patients. The studies looked at using penicillin monotherapy vs. using monotherapies of azithromycin, ceftriaxone and doxycycline and other therapies using penicillin and a mixture of the drugs above. Pen G compared with doxycycline showed no statistically significant differences in rates of curing syphilis (OR = 0.82), as well as Pen G compared with ceftriaxone showed no significant differences between cure rates of syphilis (OR = 1.66). Combination therapies the included penicillin with either azithromycin, amoxicillin, ceftriaxone, or doxycycline also had very similar cure rates as penicillin monotherapy.
The authors of this article showed that monotherapies of different drugs, as well as combination therapies that had penicillin were viable alternatives to curing patient with syphilis. The results showed the penicillin was not more effective in combating syphilis, with a slight advantage favoring cephalosporins and the combination regimens. Currently, the CDC recommends Pen G Benzathine as the first-line treatment of syphilis across all stages, but they do acknowledge that patients may have penicillin allergies and alternatives are needed. Doxycycline or tetracycline can pull its weight in being effective against both syphilis and chlamydia in cases where there was a co-infection. Further research and more randomized controlled trials are needed to solidify more alternative treatment recommendations, but I believe this is a great first step towards that goal.
