THE RESULTS OF THE TREATMENT OF EARLY
SYPHILIS WITH
PENICILLIN HAVE BEEN EXCELLENT: patients are rendered non-infectious within hours, sero-reversal to tests with
lipid antigens occurs within months and insignificant numbers of patients with cardiovascular or
neurosyphilis are found among those who have received adequate treatment. On the other hand, seropositivity to tests with treponemal
antigens may persist, sometimes indefinitely, and
reinfections are, today, by no means uncommon. The physician also has a responsibility to persuade the patient with early infectious
syphilis to induce the person who was the source of the
infection and subsequent sexual partners to undergo examination and treatment.In
late syphilis, no treatment can repair structural damage that has already occurred, e.g., severed neurons in the nervous system or loss of elastic tissue in the aortic wall, and
clinical progression may occur in spite of treatment. Nevertheless,
penicillin provides the basis of
therapy.Early
congenital syphilis, like the acquired
infection, responds well to
penicillin. However, because
benzathine penicillin penetrates poorly into the cerebrospinal fluid much higher doses of
procaine penicillin are now recommended, or alternatively the use of crystalline
penicillin G.A recent WHO Scientific Group on
Treponemal Infections has made new recommendations concerning the treatment of
syphilis and these will be considered by the next WHO Expert Committee on
Venereal Diseases, Treponematoses and Neisseria
infections. Some of these recommendations are outlined in this article.