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Long-acting penicillin (benzathine penicillin G) is the preferred treatment for early syphilis but is not always an option. The most widely used alternative, doxycycline, also has important limitations. Lately, attention has turned to another possibility: oral azithromycin.
In a recent open-label, randomized, controlled trial conducted at eight clinical sites in the U.S. and Madagascar, researchers compared azithromycin (a single 2-g dose, administered orally) with benzathine penicillin G (2.4 million units, administered intramuscularly). HIV-negative adults aged 18 to 55 with early syphilis — primary, secondary, or early latent — were eligible for enrollment. The primary endpoint was serologic cure at 6-month follow-up. Equivalence was pred…