While such large dose regimens of procaine penicillin may offer small theoretical advantages over benzathine penicillin, these regimens have low acceptance among patients and medical practitioners. For these reasons, when a procaine penicillin regimen is employed it should be preceded by an effective dose of benzathine penicillin as a safeguard against premature termination of a course of procaine penicillin. 500 mg orally 4 times a day for 20 days. Health Advice Warn the patient about the possibility of a Herxheimer reaction, and its management. Stress the importance of examining all contacts immediately.
All patients are to be referred for contact tracing.
Requires hospitalisation and treatment under consultant supervision. Health Advice Late syphilis is essentially non-communicable and contact tracing is not indicated. If CSF has been examined repeat at 3 monthly intervals until the cell count returns to normal. If the patient is allergic to penicillin treat with erythromycin 500 mg orally 4 times a day for 15 days. If the mother is treated with penicillin during pregnancy, risk to the infant is minimal and follow-up of the infant involves clinical examination at birth , serology at birth and thereafter 3 monthly until the RPR is negative.