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Sexually Transmitted Infections Treatment Guidelines, 2021


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Tertiary Syphilis										Related Pages
					Tertiary syphilis refers to gummas, cardiovascular syphilis, psychiatric manifestations (e.g., memory loss or personality changes), or late neurosyphilis. Guidelines for all forms of neurosyphilis (e.g., early or late neurosyphilis) are discussed elsewhere in these recommendations (see Neurosyphilis, Ocular Syphilis, and Otosyphilis). Persons with gummas and cardiovascular syphilis who are not allergic to penicillin and have no evidence of neurosyphilis by clinical and CSF examination should be treated with the following regimen.
Recommended Regimen for Tertiary Syphilis Among Adults**Tertiary Syphilis with normal CSF Examination:****Benzathine penicillin G** 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervalsOther Management Considerations
All persons who have tertiary syphilis should receive a CSF examination before therapy is initiated and have an HIV test. Those persons whose HIV test results are negative should be offered HIV PrEP. Persons with CSF abnormalities should be treated with a neurosyphilis regimen. Certain providers treat all persons who have cardiovascular syphilis with a neurosyphilis regimen. These persons should be managed in consultation with an infectious disease specialist. Limited information is available concerning clinical response and follow-up of persons who have tertiary syphilis.
Management of Sex Partners
See Syphilis, Management of Sex Partners.
Special Considerations
Penicillin Allergy
Any person allergic to penicillin should be treated in consultation with an infectious disease specialist.
Pregnancy
Pregnant women who are allergic to penicillin should be desensitized and treated with penicillin G. Skin testing or oral graded penicillin dose challenge might be helpful in identifying women at risk for acute allergic reactions (see Management of Persons Who Have a History of Penicillin Allergy; Syphilis During Pregnancy).
HIV Infection
Persons with HIV infection who have tertiary syphilis should be treated as described for persons without HIV (see Syphilis Among Persons with HIV Infection).Next
							
					
						Page last reviewed:  July 22, 2021					Content source: 	Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention homeSTI Treatment Guidelines, 2021
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Screening Recommendations
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Table of Contents
Summary and Introduction
Methods
Clinical Prevention Guidanceplus icon
STI and HIV Infection Risk Assessment
Primary Prevention Methods
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Expedited Partner Therapy (EPT)
Reporting and Confidentiality
Retesting After Treatment to Detect Repeat Infections
Detection of STIs in Special Populationsplus icon
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MSM
WSW and WSWM
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HIV Infection: Detection, Counseling, and Referral
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Primary and Secondary Syphilis
Latent Syphilis
Tertiary Syphilis
Neurosyphilis, Ocular Syphilis, and Otosyphilis
Syphilis Among Persons with HIV Infection
Syphilis During Pregnancy
Congenital Syphilis
Managing Persons Who Have a History of Penicillin Allergy
Diseases Characterized by Urethritis and Cervicitis
Chlamydial Infections
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Gonococcal Infections Among Adolescents and Adults
Gonococcal Infections Among Neonates
Gonococcal Infections Among Infants and Children
*Mycoplasma genitalium*
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Adolescents and Adults
Sexual Assault or Abuse of Children
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