Drug of choice for Tertiary Syphilis Procain Penicillin

Question 63

Drug of choice for Tertiary Syphilis

a.       Procaine penicillin

b.      Penicillin G

c.       Benzathine Penicillin

d.      Oral Penicillin

Answer

a.       Procain Penicillin

Reference;

Harrison 16^th Edition Table 153-3, Page 983

QTDF

Harrison

Quality

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Status

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Discussion

Treatment of Syphilis
Stage of Syphilis	Patients without Penicillin Allergy	Patients with Confirmed Penicillin Allergy
Primary, secondary, or early latent	Penicillin G benzathine (single dose of 2.4 million units IM, 1.2  million units in each buttock)	Tetracycline hydrochloride (500 mg PO qid) or doxycycline (100 mg PO bid) for 2 weeks
Late latent (or latent of uncertain duration), cardiovascular, or benign tertiary	Lumbar puncture CSF normal: Penicillin G benzathine (2.4 million units IM  weekly for 3 weeks) CSF abnormal: Treat as neurosyphilis	Lumbar puncture CSF normal: Tetracycline hydrochloride (500 mg PO qid) or doxycycline (100 mg PO bid) for 4 weeks CSF abnormal: Treat as neurosyphilis
Neurosyphilis (asymptomatic or symptomatic)	Aqueous penicillin G (18-24 million units/d IV, given in divided doses every 4 h) for 10-14 days or Aqueous penicillin G procaine (2.4 million units/d IM) plus oral probenecid (500 mg qid), both for 10-14 days	Desensitization and treatment with penicillin if allergy is confirmed by skin testing
Syphilis in pregnancy	According to stage	Desensitization and treatment with penicillin if allergy is confirmed by skin testing

Explanation

Self Explanatory

Comments

Ä     Penicillin is the DOC for Fetal Theraphy of syphilis (Nelson Table 81-5)

Ä     The signs and symptoms of syphilis are numerous; before the advent of serological testing, precise diagnosis was very difficult. In fact, the disease was dubbed the "Great Imitator" because it was often confused with other diseases, particularly in its tertiary stage.

Ä     The name "syphilis" was coined by the Italian physician and poet Girolamo Fracastoro in his epic noted poem, written in Latin, entitled Syphilis sive morbus gallicus (Latin for "Syphilis or The French Disease") in 1530. The protagonist of the poem is a shepherd named Syphilus (perhaps a variant spelling of Sipylus, a character in Ovid's Metamorphoses). Syphilus is presented as the first man to contract the disease, sent by the god Apollo as punishment for the defiance that Syphilus and his followers had shown him. From this character Fracastoro derived a new name for the disease, which he also used in his medical text De Contagionibus ("On Contagious Diseases").

Tips

Ä     Until that time, as Fracastoro notes, syphilis had been called the

o       “French disease” in Italy

o       “French disease” in Germany, and

o       “Italian disease” in France.

o       “Spanish disease” in Dutch 

o       “Polish disease” in the Russia

o       “Christian disease” or "Frank disease" (frengi) in Turkey

o        "British disease" by the Tahitians

Ä     These 'national' names are due to the disease often being present among invading armies or sea crews, due to their high amount of unprotected sexual contacts with prostitutes. It's interesting to notice how the invaders named it after the invaded country and vice versa.

Ä     It was also called "Great pox" in the 16th century to distinguish it from smallpox. In its early stages, the Great pox produced a rash similar to smallpox (also known as variola). However, the name is misleading, as smallpox was a far more deadly disease. The terms "Lues" (or Lues venerea, Latin for "venereal plague") and "Cupid's disease" have also been used to refer to syphilis. In Scotland, Syphilis was referred to as the Grandgore. It was also called The Black Lion.