Treatment of choice for a case of secondary syphilis

A 20-year-old student has a macular rash, generalized lymphadenopathy, apthous ulcers, and gray-white plaques around the anal area. A dark-field examination demonstrates spirochetes. Which of the following is the treatment of choice for this patient?

• a.Penicillin
• b.Ceftriaxone
• c.Tetracycline
• d.Interferon alpha
• e.Erythromycin

The answer is a.

Penicillin is the drug of choice for secondary syphilis. A positive darkfield examination in this patient confirms the diagnosis.

"benzathine penicillin G 2.4 million units IM or aqueous procaine penicillin G 600,000 units IM daily for ten days-In Late latent (more than 2 years), and tertiary syphilis treatment is benzathine penicillin G 2.4 million units weekly for three weeks or aqueous procaine penicillin G 600,000 units daily for 15 days.".

Ceftriaxone and tetracycline are usually considered to be alternative therapies. Interferon alpha has been used in the treatment of condyloma acuminata, a lesion that can be mistaken for syphilitic condyloma.