Oral Doxycycline May Be Effective for Early Neurosyphilis

In a small retrospective study, 200 mg doxycycline twice daily for 28 days was as effective as standard parenteral penicillin.

The era of preexposure HIV prophylaxis has seen an increase in sexually transmitted diseases such as syphilis, particularly among men who have sex with men (MSM). However, parenteral penicillin therapy for early neurosyphilis (defined as central nervous system involvement of Treponema pallidum within 2 years of infection) may be cumbersome and otherwise unsuitable for those with severe penicillin allergy.

Investigators in London retrospectively evaluated 87 patients with early neurosyphilis (median age, 35; 98% MSM; 53% HIV positive) who received intramuscular (IM) penicillin with oral probenecid for 14 days (71%), 200 mg oral doxycycline twice daily for 28 days (18%), 2 g IM or intravenous ceftriaxone daily for 14 days (3%), or a hybrid ant…

Reviewing Author

George Sakoulas, MD

Disclosures

Consultant/Advisory BoardParatek Pharmaceuticals; Nestle Corp.; AbbVie; Shionogi

Speaker’s BureauAllergan/AbbVie; Paratek Pharmaceuticals; Nestle Corp.

RoyaltiesUpToDate

Editorial BoardsAntimicrobial Agents and Chemotherapy; Open Forum Infectious Diseases