Principles and methods of syphilis therapy

Agents used in treating syphilitic patients are called specific, antisyphilitic. They are prescribed after the diagnosis has been made or as a measure for preventing the development of the disease. They are also used in ex juvantibus therapy as an aid in the diagnosis of doubtful cases (it is most frequently applied when syphilis of the internal organs or nervous system is suspected). Once the diagnosis of syphilis has been made, treatment should be started as soon as possible (within the first 24 hours in active forms). The earlier the treatment is begun, the better the prognosis and the more effective the treatment. According to order issued by Ukraine Ministry of Health and endorsed on June 06, 2004, besides antisyphilitic agents producing a direct effect on T. pallidum (mainly in the period of active reproduction), non-specific agents are widely used to produce a general invigorating effect and help the body to overcome the infection. Non-specific therapy is applied at the same time as the specific antisyphilitic agents. The later the treatment begins, the longer the causative agent remains in the patient's body, the more non-specific therapy is substantiated.

Penicillin and its derivatives are now the principal agents used in treating syphilis. Penicillin is used as a sodium or potassium salt. Its derivatives are long-acting agents. These are bicillin-1, bicillin-3 and bicillin-5.

Water-soluble penicillin is given as a single intramuscular injection every three hours around-the-clock in a dose of 500 000 U to 1 000 000 U. Duration of the therapy depends on stage of syphilis. This is the main method of treatment in the hospital. The novocaine salt of bensilpenicillin as its foreign analogue procaine-penicillin G is given as an intramuscular injection 1-2 times a day in a dose of 1 500 000 U to 3 000 000 U. The main preparation for treatment patients with early syphilis in out-patients' department is benzathine penicillin (bicillin-1, extencillin, retarpen, procaine-penicillin). They are given in a single intramuscular dose one time a week. Bismuth salts (bioquinol, bismoverol and a water-soluble agent pentabismol) and iodine preparations are used sometimes as group of reserve in the treatment of syphilis patients with late forms of syphilis.

Before use the flask with bioquinol or bismoverol is heated in 40-45°C water and the contents are shaken thoroughly till a homogeneous suspension is produced. Bioquinol and bismoverol, like the long-acting penicillin preparations, are injected with a pause into the muscles of the superolateral quadrant of the buttocks. Pentabismol is injected without a pause. Women in pregnancy (with latent or active syphilis) as well as patients suffering from syphilis and active forms of tuberculosis are not given bismuth preparations.

Iodine preparations are prescribed as potassium iodide or sodium iodide solutions. One tablespoonful is given on the first day, two tablespoonfuls on the second day and three tablespoonfuls three times a day on the third and following days. The solution is taken in half a glass of milk after a meal. Solutions of gradually increasing concentrations (from 2-3 to 7-8 per cent) are used. Treatment lasts 3 to 4 weeks.

The instructions issued by Ukraine Ministry of Public Health contain several schedules for antisyphilitic treatment.