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Systematic review
Penicillin is the drug of choice to treat all stages of syphilis despite a paucity of clinical trials data for the treatment of some stages, pregnant women and HIV-infected people
  1. Susan Tuddenham,
  2. Khalil G Ghanem
  1. Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to : Dr Khalil G Ghanem, Johns Hopkins University School of Medicine, JHUBMC, 5200 Eastern Ave, MFL Center Tower Suite 378, Baltimore, MD 21224, USA; kghanem{at}

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Syphilis rates are increasing particularly in men, many of whom are HIV co-infected. In some areas, syphilis continues to affect women leading to high rates of congenital infections. Non-treponemal serological tests are still the mainstay of staging and assessing response to therapy. These tests are, at best, an indirect marker of disease activity. In some cases, changes in non-treponemal titres may reflect factors other than syphilis infection.1 In the pre-antibiotic era, people with early syphilis, whose non-treponemal antibody tests failed to revert to negative (ie, remained ‘serofast’), had a worse long-term prognosis.

This systematic review examines the evidence supporting penicillin and non-penicillin-based regimens for the treatment of: (1) the different stages of syphilis; (2) pregnant women and (3) HIV-infected people. The …

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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.