First Trimester

Can Antibiotics Help Treat Syphilis?

Can Antibiotics Help Treat Syphilis?

Key Takeaways

  • Penicillin is an effective treatment for syphilis.
  • Penicillin is a beta-lactam antibiotic.
  • Penicillin is an antibacterial drug that was discovered by accident.

Yes, antibiotics are the only medication or it is better to say, the only possible medical approach towards syphilis in the current day. Penicillin is the best treatment used to fight syphilis at all stages of the infection. Even for pregnant women, penicillin is considered the safest treatment for the fetus. Even if the woman has allergy to penicillin, desensitization undergone and penicillin is administered. Under normal circumstances, when a person has allergy to penicillin, doxycycline and tetracycline can also be used.

History of Penicillin

Penicillin was discovered in 1928 by Alexander Fleming. When he was working in St. Mary’s Hospital in London, he was growing a culture of staphylococcus which was contaminated by a mold of genus penicillium. He saw that staphylococcus growth was inhibited around that mold, then he isolated it in pure form and proved that it possesses antibacterial properties. In 1941, the antibacterial properties were clearly demonstrated when a small amount of penicillin was given to policeman who had staphylococcal and streptococcal septicemia with multiple abscess. Leading up to today, there is a long history of clinical trials for the application of penicillin in the treatment of syphilis and other infections.

Mechanism of action

How penicillin works in the body is very important to understand. Since there are no surgical treatment options available for syphilis (and oftentimes for infections), giving medication like penicillin is the only option to treat syphilis. Penicillin is a beta-lactam antibiotic which acts on the cell wall of the bacteria. It inhibits the last stage of the cell wall synthesis. Therefore, it works best when the bacteria are dividing actively. 

How Penicilin is delivered

Penicillin is mostly given intramuscularly or intravenously. Oral administration of penicillin should be avoided because it may be degraded by acid in the stomach or become adsorbed by foodstuffs. In the early stages of syphilis, a single intramuscular administration of penicillin is enough to eliminate the disease, but in the later stages, like the tertiary stage, intravenous penicillin should be given. The Penicillin drug can cure a patient who either has primary, secondary, or very early latent syphilis. Three doses of slow acting Benzathine penicillin G (2.4 million units) every week are generally administered intramuscularly to patients with late latent syphilis or latent syphilis of unknown duration. Treatment can destroy the syphilis infection and prevent further damage, but it cannot undo the damage that has already been done.

If a patient with neurosyphilis has to be treated, then a different penicillin preparation should be selected, because all penicillin preparations cannot reach cerebrospinal fluid readily. Benzathine Penicillin G (BPG) has to be given in high doses. The preparation most widely used is benzathine penicillin because penicillin is released very slowly and Treponema bacteria divide very slowly. Penicillin should be given in bactericidal concentration for a few weeks, to be sure that the infection is thoroughly destroyed, and that it doesn't develop a resistance to penicillin. Treponema bacteria has not yet developed a resistance to penicillin, and therefore remains an effective treatment.

Although studies that support the use of drugs other than penicillin are few and far between, there are options for patients who are not pregnant and who are allergic to penicillin. The patient may be given doxycycline and tetracycline. And for those patients that suffer from neurosyphilis, another drug called ceftriaxone may be administered. These treatments must be adopted only when supported by follow up tests and a thorough clinical approach so that the patient is cured in an optimum manner.

It is vital to choose the correct dosage and drug to treat Syphilis. It would be wrong to combine different types of penicillin such as Procane penicillin and Benzathine penicillin (Bicillin CR) because the dosage provided by these combinations are not strong enough to defeat syphilis. The patient’s treatment will be severely compromised if such an inadequate antibiotic course is administered.

Costs for treatment

Approximately 6.5 billion dollars is spent in a year on all sexually transmitted infections. It has been estimated by a study that $444 is required per new case of syphilis. The initial cost of treating neurospyhilis is about $4,857. The cost for treatment of neurosyphilis is approximately $56,374 for one patient, assuming a large amount of time elapses before their first treatment. For this reason, it is important to get an accurate diagnosis early in the syphilis life cycle. The primary and secondary syphilis treatments require around $380 for initial treatment.

Adverse reactions

All medications have some kind of side effects, which can range from mild to severe. More than half of the patients who have secondary syphilis who are being treated with antibiotics often have the Jarisch-Hexheimer reaction. Such patients often suffer from acute fever, headache and pain in muscle within the first 24 hours of medication. This reaction occurs due to toxins released by destroyed bacteria. TNF (Tumor Necrosis factor) is responsible for this reaction. It is important to call for emergency help if there are problems in breathing or swelling of face and throat.  

Syphilis in Pregnant Women

All female patients must be tested in early pregnancy for syphilis. In areas where prenatal care is not a priority the mother should be screened and treated as soon as her pregnancy is confirmed. There are some places where syphilis is widespread and women are in the high-risk category for infection. Blood tests must be performed at least two times in the third trimester. First at around the 30-week gestation period, and then once again after delivery.

A pregnant woman with a positive blood test should be classified as infected unless a comprehensive treatment timeline is clearly recorded in her medical history. To prevent transmitting the infection from the mother to the fetus, and to treat the fetal infection, the only effective antibiotic is Benzathine Penicillin G.

There are studies that suggest that a therapeutic regimen is a positive step in the treatment of syphilis for pregnant women. For a patient who has primary, secondary, or latent syphilis, another dose of benzathine penicillin can be given intramuscularly one week after the first dose. If the infection is detected in the third trimester of pregnancy, the patient should undergo fetal sonography for syphilis. However, this test should not delay the administration of antibiotics. A patient undergoing treatment during the secondary stage of pregnancy is at risk for going into fetal distress or premature labor if she suffers from the Jarisch-Herxheimer reaction. These patients must be warned to seek immediate medical attention if they get fever, labour contractions, or fewer fetal movements.