• Penicillin G, administered parenterally, is the preferred drug for treating all stages of syphilis. 

• Combinations of benzathine penicillin, procaine penicillin, and oral penicillin preparations are not considered appropriate for the treatment of syphilis.

• Pregnant women should be treated with the penicillin regimen appropriate for their stage of infection.

• Click here to view syphilis treatment guidelines for HIV-infected persons.

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Primary Syphilis

• Recommended Regimen for Adults

  Benzathine penicillin G 2.4 million units IM in a single dose

• Recommended Regimen for Infants and Children

  Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of 2.4 million units in a single dose

 

Latent Syphilis

• Recommended Regimens for Adults

  Early Latent Syphilis

  Benzathine penicillin G 2.4 million units IM in a single dose
  Late Latent Syphilis or Latent Syphilis of Unknown Duration
  Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervals

• Recommended Regimens for Children
  Early Latent Syphilis
  Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of 2.4 million units in a single dose
  Late Latent Syphilis or Latent Syphilis of Unknown Duration
  Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of 2.4 million units, administered as 3 doses at 1-week intervals (total 150,000 units/kg up to the adult total dose of 7.2 million units)

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​Tertiary Syphilis

• Recommended Regimen

  Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervals

   

Neurosyphilis

• Recommended Regimen
  Aqueous crystalline penicillin G 18–24 million units per day, administered as 3–4 million units IV every 4 hours or continuous infusion, for 10–14 days

• Alternative Regimen
  Procaine penicillin 2.4 million units IM once daily
  PLUS
  Probenecid 500 mg orally four times a day, both for 10–14 days