Azithromycin Might Cure Early Syphilis, but Beware of Failure

Benzathine penicillin has been the treatment of choice for early-stage syphilis for 50 years. Although drug resistance has never hampered its efficacy, alternative treatments are still needed for penicillin-allergic patients and for those living in countries where safe intramuscular injections are cumbersome to provide.

Researchers randomized 328 Tanzanian patients with early syphilis to receive either a standard 2.4-mU intramuscular injection of benzathine penicillin or a single oral 2.0-g dose of azithromycin. Twenty-five subjects had primary syphilis with chancres, and 303 had early latent syphilis, with rapid plasma reagin (RPR) titers of ≥1:8; HIV infection was present in 52%. Treatment success, defined by prompt healing of chancres and…