Pediatric emergency medicine trisk 2413 2413
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Possible
Unlikely
Serologic criterion one or two
with ≤1 minor criterion
Maternal history of adequate
treatment during pregnancy
(penicillin-based regimen) +
nonreactive serologic test
for syphilis
XR, radiographs; CNS, central nervous system; CSF, cerebrospinal fluid; RPR, rapid plasma reagin; VDRL,
venereal disease research laboratory; FTA-ABS, fluorescent treponemal antibody absorption; TP-PA,
Treponema pallidum particle agglutination; MHA-TP, microhemagglutination test for antibodies to
Treponema pallidum.
Modified from Mascola L, Pelosi R, Blount JH, et al. Congenital syphilis revisited. Am J Dis Child
1985;139:575–580.
e-TABLE 94.32
TREATMENT OF SYPHILIS
Stage
Primary, secondary, or early latent
(infection within the last 12 mo)
Treatment
Penicillin G benzathine 50,000
units/kg (maximum: 2.4 million
units) IM once
Late latent (>1 yr since acquisition),
Penicillin G benzathine 50,000
latent syphilis of unknown duration,
units/kg (maximum: 2.4 million
or tertiary syphilis
units) IM weekly for 3 wks
Congenital syphilis or neurosyphilis
Aqueous penicillin G 50,000
units/kg/dose IV every 12 hrs in 0–7
do, then every 8 hrs in infants > 7
days (maximum daily dose: 24
million units/day) for 10 days
Alternative regimen for adults:
Procaine penicillin G 24 million
units IM daily with probenecid 500
mg four times daily for 10–14 days
IM, intramuscular; IV, intravenous.
