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<sup>1</sup> Alternative tx not well studied in HIV pts; use only w/ close clinical/serologic f/u; azithromycin not recommended.<br><br>
<sup>2</sup> Compliance likely better w/ doxycycline vs tetracycline due to GI side effects and more frequent dosing of tetracycline.
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<sup>3</sup> Based on limited data, optimal dose/duration of ceftriaxone undefined.
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<sup>4</sup> Examples of neuro signs: Cognitive dysfunction, motor/sensory deficits, eye/auditory sx, cranial nerve palsies, s/sx of meningitis or stroke.
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<sup>5</sup> CSF abnormalities (mononuclear pleocytosis, ↑protein) common in HIV pts, even those w/o syphilis; CSF eval not associated w/ improved outcome in HIV pts w/o neuro s/sx. All HIV(+) pts w/ syphilis should have a careful neuro exam.
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<sup>6</sup> Jarisch-Herxheimer: Acute febrile rxn (HA, myalgia, fever, other sx) can occur w/in first 24h after the initiation of syphilis tx; most frequent among pts w/ early syphilis. Antipyretics can be used to manage sx, but not proven to prevent the rxn.
<sup>2</sup> Compliance likely better w/ doxycycline vs tetracycline due to GI side effects and more frequent dosing of tetracycline.
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<sup>3</sup> Based on limited data, optimal dose/duration of ceftriaxone undefined.
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<sup>4</sup> Examples of neuro signs: Cognitive dysfunction, motor/sensory deficits, eye/auditory sx, cranial nerve palsies, s/sx of meningitis or stroke.
<br><br>
<sup>5</sup> CSF abnormalities (mononuclear pleocytosis, ↑protein) common in HIV pts, even those w/o syphilis; CSF eval not associated w/ improved outcome in HIV pts w/o neuro s/sx. All HIV(+) pts w/ syphilis should have a careful neuro exam.
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<sup>6</sup> Jarisch-Herxheimer: Acute febrile rxn (HA, myalgia, fever, other sx) can occur w/in first 24h after the initiation of syphilis tx; most frequent among pts w/ early syphilis. Antipyretics can be used to manage sx, but not proven to prevent the rxn.
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Treat w/ benzathine penicillin G 2.4 MU IM x1