The number of syphilis cases is on the rise, according to a report from the Centers for Disease Control and Prevention . The CDC-recommended treatment for early syphilis is one dose of benzathine penicillin G, but there is debate among clinicians about whether three weekly doses are needed, particularly among persons with HIV. Researchers at the University of Alabama at Birmingham have published a study in the New England Journal of Medicine suggesting one dose of BPG is as effective as the three-injection regimen at treating early syphilis. The National Institutes of Health funded the research.
"These results will help physicians simplify the treatment of syphilis for patients and reduce the time and inconvenience associated with multiple injections of penicillin administered in the past," said Edward Hook III, M.D., lead author of the study and a professor of medicine and epidemiology in the UAB Division of Infectious Diseases .
Syphilis is an acute and chronic human bacterial sexually transmitted infection (caused by Treponema pallidum) that has been recognized as a threat to human health for centuries. In 2023, the United States reported more than 209,000 cases of syphilis — the greatest number of cases reported since 1950 — and 3,882 cases of congenital syphilis. Without treatment, syphilis can result in neurological and organ damage, as well as adverse pregnancy outcomes and congenital abnormalities. Syphilis can also increase a person's likelihood of acquiring or transmitting HIV. While BPG has been used as a primary treatment for syphilis for decades, treatment with BPG has been hampered by stock-outs and periodic shortages.
"We are living in era of unreliable stock of the BPG drug supply to treat syphilis, which has led to the use of alternative therapies that may not be as effective," said Jodie Dionne , M.D., associate professor of medicine and co-author of the paper. "Now that we know one dose of the drug is just as effective as three doses, this helps extend our local and national drug supply to treat as many people as we can."
The study, which was open to anyone with early syphilis, enrolled 249 persons at 10 sites across the United States. Ninety-seven percent of participants were men, 62 percent were Black, and 64 percent were living with HIV infection. According to the study authors, these findings provide substantial evidence that the current treatment guidelines of treating early syphilis with a single dose of penicillin is as effective as the three-injection method.
Read the full study here .
