Syphilis

Primary Treponema pallidum infection manifests as a painless genital ulcer known as a chancre (Fig. 40-15). Diagnosis is typically confirmed with a combination of nontreponemal screening tests (rapid plasma reagin [RPR], Venereal Disease Research Laboratories [VDRL]) and a treponema-specific test (fluorescent treponemal antibody absorption [FTA-ABS]). T. pallidum is difficult to culture, so darkfield microscopy or fluorescent antibody testing of a tissue specimen provides definitive diagnosis. Primary syphilis is treated with a single dose of penicillin, 2.4 million units IM in adults and 50,000 to 2.4 million U/kg IM in children) (CDC, 2006).

Table 40-10 Treatment for Selected Sexually Transmitted Infections (STIs)

STI

Medication

Dose

Route*

Duration

Chancroid

Azithromycin

1000 mg

PO

Single dose

Ceftriaxone

250 mg

IM

Single dose

Ciprofloxacin

500 mg

PO

Twice daily for 3 days

Erythromycin base

500 mg

PO

Three times daily for 7 days

Chlamydia

Azithromycin

1000 mg

PO

Single dose

Doxycycline

100 mg

PO

Twice daily 7 days

Gonorrhea

Cefixime

400 mg

PO

Single dose

Ceftriaxone

125 mg

IM

Single dose

Syphilis, primary

Penicillin

2.4 million U

IM

Single dose

"PO, Oral; IM, Intramuscular.

Doxycycline and tetracycline are alternatives for penicillin-allergic patients.

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