Effective medicines for syphilis. Rapid and preventive treatment of syphilis: methods, regimens, courses, methods, instructions. Treatment of syphilis with durant drugs

Treatment of syphilis, methods, regimens and drugs at different stages of the disease

For five centuries, patients with syphilis were treated with mercury preparations. This was explained by the fact that Treponema pallidum is very sensitive to compounds of mercury, bismuth, arsenic and iodine, which block the enzymes of the microbe. However, this treatment was not effective enough due to high toxicity. According to some data, with this treatment up to 80% of patients died from an overdose of mercury.

Modern medicine uses more humane treatment methods.

The first thing to do if you suspect syphilis is to exclude any sexual contact until complete cure, and the sexual partner that the patient had during the expected incubation period must also be carefully checked.

For now the disease is treated at all stages , but its treatment requires a competent and responsible approach on the part of the doctor, as well as strict compliance by the patient with all treatment instructions.

Drug treatment primarily based on application antibacterial drugs and penicillin antibiotics. The fact is that treponema pallidum is almost the only microorganism that, despite decades of penicillin therapy, is still highly sensitive to penicillin and its derivatives and does not have antipenicillin protection.

Only in cases of special resistance isolated from a sick strain to penicillin derivatives or the patient is allergic to penicillins can be used alternative treatment regimen with antibiotics of other pharmacological groups:

• Macrolides (erythromycin, medicamycin)
• Tetracycline antibiotics (tetracycline)
• Streptomycins and fluoroquinolones (ciprofloxacin, ofloxacin)
• Azithromycins

Early stages of the disease are easier to cure than older stages. For example at the initial stage Antibacterial treatment lasting about three months is optimal and, as a rule, leads to a complete cure. However in later stages treatment can last up to two years.

For the doctor it is important to fix before starting treatment results of serological studies. Since after the end of the course of treatment, repeated serological tests are necessary, which will show the dynamics of the cure and its result.

After treatment has been prescribed, it is necessary a series of visits to the treating venereologist so that he can monitor the activity of the infection and the effectiveness of treatment. This also allows the doctor to make the necessary adjustments to the treatment regimen.

There are times when there is a need for repetition course of antibiotic therapy.

Besides, The use of immunostimulating drugs is also important in treatment , since Treponema pallidum has the ability to seem to “elude” the immune system.

At a fairly advanced stage of the disease in the tertiary period and if at the same time there is pronounced resistance of Treponema pallidum to antibiotics, and the patient feels quite well, then toxic therapy is allowed. That is, the doctor can add to antibiotics derivatives of arsenic (miarsenol, novarsenol) or bismuth (biyoquinol).

When diagnosing this sexually transmitted disease during pregnancy , the woman is prescribed two mandatory courses of treatment.

• The first and main course is carried out only inpatiently immediately after confirmation of the diagnosis.
• The preventive course can be carried out both in a hospital and in a home outpatient clinic for a period of twenty to twenty-four weeks.

This the treatment is quite successful and almost completely reduces the possibility of developing a congenital infection in a child.

However, after birth, The child must be examined.

It is worth keeping in mind that the body does not develop any effective specific immunity to the causative agent of syphilis. Therefore, having been cured once, the patient is not at all immune from the possibility of infection again.

Medicines for the treatment of syphilis: tablets and medicines in other forms

Treatment for infection can be quite lengthy, especially if the person did not apply at the first alarming sign. Usually, treatment is carried out for two years with further examination and serotology every six months.

• In early forms diseases (primary, secondary and latent duration less than one year) are used penicillin antibiotics.

Primarily used benzathinebenzylpenicillin once intramuscularly 2.4 million units or procainebenzylpenicillin intramuscularly, 600,000 units per day for eight days.

Your doctor may also prescribe single doses of other antibiotics and bijoquinol, bismoverol (bismuth preparations).

• At late latent course of the disease benzathinebenzylpenicillin Prescribe 2.4 million units intramuscularly once a week for three weeks.

And for patients with neurosyphilis benzylpenicillin indicated intravenously for 10 days or more.

The duration of treatment depends solely on the form of syphilis, as well as individual drug tolerance, and the patient’s physical condition.

If the patient is allergic to penicillin, prescribe erythromycin or tetracycline , 500 mg four times a day for 30 days.

Antibiotics of other pharmacological groups are also used:

• Macrolides
• Streptomycins and fluoroquinolones (ofloxacin, ciprofloxacin)
• Azithromycins

Although effectiveness of some macrolides It has not been confirmed by the instructions of the Ministry of Health, therefore tetracycline derivatives or cephalosporins are more often used.

Features of aminoglycosides is that they suppress the rapid reproduction of Treponema pallidum only in very high doses. But such doses have too toxic an effect on the human body. Therefore, in the form of monotherapy the use of aminoglycosides is not recommended.

Also the ineffectiveness of sulfonamides has been proven.

• For the treatment of pregnant women and children younger people choose erythromycin and ceftriaxone. These drugs do not have a negative effect on the fetus.

Also in addition to penicillin therapy Pregnant women are prescribed preventive treatment after treatment.

When treated with drugs penicillin such a type of disease as neurosyphilis is mandatory combination intramuscular or oral administration of antibacterial drugs with pyrotherapy with their endolumbar administration, which increase the permeability of the blood-brain barrier.

If the stage of the disease is already quite advanced and the infection develops in the tertiary period. In addition, treponema pallidum exhibits pronounced resistance to antibiotics, so a venereologist can add to general therapy drugs miarsenol or novarsenol (arsenic derivatives) or bioquinol(bismuth). But the patient’s condition must be satisfactory, since these drugs are quite toxic.

Can also be assigned immunostimulating drugs. They will improve weakened immunity or eliminate immunodeficiency conditions.

It should be kept in mind that any types of antisyphilitic therapy are used exclusively in specialized medical institutions according to special regulations and Using these drugs on your own is dangerous to your health and life.

Treatment regimen for various stages of syphilis in table form + photo

Syphilis latent early

Profile: therapeutic, specialty - dermatovenerologist.
Treatment stage: hospital
Purpose of the stage: receiving a full course of specific treatment; prevention of late relapses.
Duration of treatment: Day 28

ICD codes: A51.5 Early latent syphilis.

Definition: Syphilis is an infectious disease characterized by immunological failure, caused by Treponema pallidum, transmitted predominantly sexually with a characteristic periodization of clinical symptoms, capable of affecting all organs and systems.
Latent early syphilis is a type of syphilis that takes a latent course from the moment of infection, without clinical signs of the disease, with positive serological reactions with a duration of infection of up to 2 years.

Classification:
1. Primary seronegative syphilis.
2. Primary seropositive syphilis.
3. Secondary fresh syphilis.
4. Secondary recurrent syphilis.
5. Latent early syphilis, lasting up to 2 years.
6. Serorecurrent syphilis.
7. Seroresistant syphilis.
8. Tertiary syphilis.
9. Late latent syphilis. Syphilis (acquired) without clinical manifestations with a positive serological reaction 2 years or more from the moment of infection.
10. Latent syphilis, unspecified. Cases with a positive serological reaction to syphilis when it is impossible to determine the timing of infection. This group includes persons who began treatment at a previously unknown stage of syphilis.
11. Early congenital syphilis. Congenital syphilis in infancy (up to 1 year) and early childhood (up to 2 years).
12. Late congenital syphilis more than 2 years old.
13. Latent congenital syphilis.
14. Syphilis of the nervous system: early - when the syphilitic infection is less than 2 years old; late - when the syphilitic infection has been more than 2 years old.
15. Tabes dorsalis.
16. Progressive paralysis.
17. Visceral syphilis indicating the affected organ.

Risk factors:
Promiscuous sexual intercourse, very rarely with indirect contact with a sick person through objects (toothbrushes, spoons, smoking pipes, etc.), intrauterine transmission from a sick mother to a child, with direct blood transfusion, through the milk of a sick nursing woman to a child. The risk of developing early latent syphilis: taking a large number of antibiotics for other diseases, self-medication, lack of awareness about sexually transmitted diseases.

Admission: planned.

Indications for hospitalization:
1. Socially unadapted people; minors delivered from the Center for Temporary Isolation for Adaptation of Rehabilitation of Minors with positive serological reactions.
2. Persons working in organized teams with positive serological reactions.

The required scope of examinations before planned hospitalization:
1. General blood test;
2. General urine analysis;
3. Feces on worm eggs;
4. Fluorography;
5. Wasserman reaction;
6. Blood test for HIV.

Diagnostic criteria:
1. Anamnesis data: taking antibiotics and other antibacterial drugs, blood transfusions, etc. in the last 2 years, presence in the past of eruptive elements-erosions, ulcers, as a rule, after casual sexual intercourse; results of external examination: secondary residual elements - scars, spots, enlarged regional lymph nodes.
2. Positive serological reactions (Wassermann reaction, immunofluorescence reaction, Treponema pallidum immobilization reaction, enzyme immunoassay, passive hemagglutination reaction) in the absence of clinical manifestations.
3. Herxheimer-Jarisch reaction (fever) after starting antibiotic therapy.
4. Relatively rapid negativity of serological reactions against the background of specific antisyphilitic treatment.

List of basic diagnostic services:
1. General blood test
2. General urine test
3. Blood test for HIV
4. ELISA-HBsAg
5. Enzyme-linked immunosorbent assay (ELISA)
6. Immunofluorescence reaction
7. Feces on me/worm
8. KSR.

List of additional diagnostic services:
1. Consultation with a therapist according to indications
2. Consultation with an ophthalmologist according to indications
3. Consultation with an otolaryngologist according to indications
4. Examination of smears for gonorrhea, trichomoniasis and yeast fungus
5. Chlamydia ELISA according to indications
6. Immunogram.

Treatment tactics:

Etiotropic therapy:
Method 1: Treatment is carried out with benzathine benzylpenicillin, 2.4 million units per injection, once a week, No. 3; or bicillin-1, 2.4 million units per injection, once every 5 days, No. 6.

Method 2: Treatment is carried out with bicillin-3, administered at a dose of 1.8 million units 2 times a week - No. 10; or bicillin-5 in a single dose of 1,500,000 units, administered 2 times a week - No. 10.

Method 3: Procaine-penicillin is used in a single dose of 1.2 million, daily for a course - No. 20, or novocaine salt of penicillin at 600,000 units 2 times a day - 20 days.

Method 4: Therapy is carried out with water-soluble penicillin, 1 million units every 6 hours, 4 times a day for 20 days.

Method 5:(used only for hypersensitivity to both penicillin and cephalosporin antibiotics):
Doxycycline is used 0.1 g every 8 hours 3 times a day for 30 days, 9 g per course; or tetracycline 0.5 g every 6 hours 4 times a day for 30 days, for a course of 60 g.
Erythromycin 0.5 g per dose 4 times a day, for 30 days, every 6 hours, for a course of 60 g.
Azithromycin 0.5 g every 12 hours 2 times a day for 3 weeks.

Method 6: Cefazolin 1.0 g every 4 hours 6 times a day for 28 days.

Method 7: Ceftriaxone 1.0 x 1 time per day every other day intramuscularly, course dose 10.0 g.

To prevent intestinal dysbiosis, antifungal therapy is prescribed: itraconazole oral solution 200 mg 2 times a day for 21 days or flucanozole 150 mg once every 3 days - 2-3 courses.

List of essential medications:
1. Benzylpenicillin. por d/i 1000000 units, fl
2. Cefazolin 1 g, fl
3. Ampicillin 1 g, fl
4. BenzathinebenzylpenicillinG 2.4 million units, fl
5. Benzylpenicillin novocaine salt 600,000 units, fl

List of additional medications:
4. Doxycycline 100 mg, tablet
1. Erythromycin 500 mg, tablet
2. Azithromycin 500 mg, tablet
3. Tetracycline 100 mg, 200 mg, tablet
4. Itraconazole oral solution 150 ml – 10 mg\ml
5. Flucanozole 150 mg, tablet
6. Ceftriaxone 1 g, fl
7. Vitamins B, C
8. Immunomodulators: methyluracil 500 mg tablet, cycloferon amp.
9. Biostimulants: aloe, vitreous body &

Criteria for transfer to the next stage: full course of specific treatment.
Patients who have received specific treatment are subject to clinical and serological monitoring for 3 years with the frequency of donating blood for the Wasserman reaction once every 3 months.

»» No. 7 "98 »» New medical encyclopedia

T.V. Krasnoselsky Questions and answers

In an epidemic, cases of syphilis are becoming routine in the practice of doctors of all specialties. Considering that this infection is characterized by a wide variety of clinical symptoms and can simulate the manifestations of many skin and somatic diseases, we asked to answer questions about the routes of infection with syphilis, its diagnosis and modern methods of treating candidosis. honey. Sciences, assistant at the Department of Dermatovenereology with the clinic of St. Petersburg State Medical University named after. acad. I.P. Pavlova Tatyana Valerievna Krasnoselskikh.

Epidemiological situation
Since 1989, Russia has seen an epidemic increase in the incidence of syphilis. In St. Petersburg during the 90s it increased 35 times and reached its peak in 1995. In 1996-97, according to official statistics, a decrease in incidence was noted. For the first time in many years, it was lower than the Russian average. However, there is a high probability of unreliability of these indicators due to the lack of information from private practitioners and commercial structures providing dermatovenerological, gynecological and urological care.
Currently, the epidemiological situation regarding the incidence of syphilis in St. Petersburg remains unfavorable. This is confirmed by an increase in the number of patients with late and unspecified forms, the number of those infected again, the number of children with congenital and domestic syphilis, and the increase in the registration of syphilis among pregnant women. According to scientists' forecasts, in the coming years we should expect an increase in the registration of late and latent forms of syphilis, damage to the nervous system, internal organs, and a further increase in congenital and domestic syphilis.

- Until recently, students were taught: “Household syphilis is a poorly collected anamnesis.” But now this concept is again entering the vocabulary of doctors. Is this related to the current epidemiological situation?
- In 95-98% of all cases, syphilis infection occurs through sexual contact with a patient. The everyday route of transmission of infection - through kisses, bites, through any objects contaminated with material containing pathogens - is very rarely realized in practice, since the infectious material loses its contagiousness as it dries.
But, despite its rarity, the household route of transmission of infection should not be ignored. Suffice it to say that in 1997 in St. Petersburg, 20 cases of domestic infection of children from parents with syphilis were registered. Therefore, according to existing instructions, children under 3 years of age who have particularly close contact with parents with syphilis, even with negative results of serological reactions, are required to receive preventive treatment; the issue of treatment for older children is decided individually.
- Is it possible to become infected with syphilis through medical instruments or during medical procedures?
- Infection through reusable medical instruments (uterine and rectal speculum, dental instruments, etc.), subject to the basic rules of its processing, is excluded.
Currently, the transfusion route of infection is practically not encountered. This is due to the fact that, firstly, serological testing is carried out on all donors before blood collection; secondly, with the fact that the causative agent of syphilis - Treponema pallidum - is a facultative anaerobe, and tissues with a high oxygen content are not suitable for its existence. Using blood as a transport medium for dissemination throughout the body, Tr. pallidum is found in it only at certain stages of the disease. But even if we imagine that the blood was taken from an unexamined donor during the period of so-called “treponemal sepsis,” then when it is preserved, the pathogen dies within 3-5 days. Thus, only direct blood transfusion is dangerous, the indications for which are currently extremely narrowed.
- Why in some cases does infection not occur when contacting someone with syphilis?
- When in contact with a person with syphilis, up to 15-20% of partners remain healthy. Several reasons can be identified for this:
1. lack of conditions necessary for infection - a sufficient number of virulent Treponema pallidums in the infectious material and an “entry gate” for infection (microtraumas of the stratum corneum of the skin or the epithelium of the mucous membrane);
2. one-time or rare sexual intercourse;
3. absence or low contagiousness of syphilides during sexual intercourse;
4. individual immunity of some individuals to infection, associated with the presence in the blood serum of special proteins that immobilize and lyse treponema.
The most contagious are patients with early forms of syphilis, which currently include all cases of the disease that do not exceed 2 years in duration. With late (latent and tertiary) syphilis, infection of contact persons rarely occurs.
In a patient with primary and secondary syphilis, any erosive, weeping rash is highly contagious. The so-called “dry” syphilides (for example, roseola, non-erosive papules, leucoderma) and papulopustular elements are less dangerous. Manifestations of the tertiary period (tubercles, gummas) are practically non-contagious. The patient's saliva is contagious in the presence of specific rashes on the oral mucosa, and the milk of nursing women, semen and vaginal secretions are contagious even in the absence of active manifestations of the disease in the area of ​​the mammary glands and genitals. According to most researchers, the secretion of the sweat glands, tear fluid and urine of patients with syphilis do not contain pathogens. In patients with active syphilis, all nonspecific lesions are contagious, leading to disruption of the integrity of the skin and mucous membranes - herpetic rashes, cervical erosion, banal balanitis, etc.
- Have methods for detecting syphilis in the incubation period been developed to date?
- Yes, such methods exist, but, unfortunately, they are not introduced into everyday practice due to high cost and technical complexity. In this regard, if no more than 2 months have passed since the suspected infection, all contact persons who do not have clinical and serological signs of the disease are given preventive (precautionary) treatment. If more than 2 months have passed since the moment of contact, and during this time no signs of the disease have appeared, then preventive treatment is not carried out, and the contact person remains under the supervision of a venereologist for six months.
- Are there ways to prevent syphilis infection?
- Since rashes in patients with syphilis can be localized on any part of the skin or mucous membranes, the use of condoms does not protect against infection. Condoms only reduce the likelihood of infection and protect against concomitant urogenital infections.
Individual prevention of infection, which consists of treating the genital area with disinfectants (gibitan, cidipal, miramistin), is effective only during the first 2 hours after sexual intercourse, since 2-4 hours after infection the pathogen enters the lymph nodes and occurs within the first day generalization of infection.
- What are the earliest clinical manifestations of syphilis?
- After an incubation period, the average duration of which is 30 days (from 9 days to 6 months), the so-called primary affect (chancroid), from now on it begins primary period syphilis. Its average duration is 45 days.
In the current epidemiological situation, every practitioner should remember that if a patient has single or multiple erosive or ulcerative elements on the genitals, syphilis should first be suspected and, to rule it out, the patient should be referred to a venereologist. Particular suspicion should be caused by painless defects of rounded outline with a dense infiltrate at the base, with clear, smooth, not undermined edges, a smooth bottom, scanty serous discharge, without signs of inflammation along the periphery.
It is completely unacceptable to prescribe any external agents, especially disinfectants and ointments with antibiotics, or general antibiotic therapy, before establishing a diagnosis. This will significantly complicate or make it impossible to detect the pathogen in the discharge of the primary affect. In addition, taking treponemocidal drugs in inadequate, subtherapeutic doses, without leading to the cure of syphilis, helps to resolve all its external manifestations and the transition of the disease to a latent form. Patients with latent syphilis, while remaining dangerous from an epidemiological point of view, know nothing about their disease and are most often detected by chance during a serological examination.
The attention of the patient and the doctor may also be attracted regional scleradenitis- enlargement and thickening of the lymph nodes adjacent to the primary affect, which occurs simultaneously or a few days after its appearance. Detection of unilateral or bilateral enlargement of a group of lymph nodes (especially often inguinal), which have a dense elastic consistency, are mobile, painless, and are not accompanied by skin changes, should always raise suspicion of syphilis. In such cases, a thorough examination of the patient and his serological examination are necessary. It is unacceptable to prescribe treatment to patients (especially antibiotics!) for “lymphadenitis of unknown etiology.”
10-14 days before the end of the primary period, patients may experience polyadenitis and prodromal phenomena- weakness, fatigue, malaise, headache, low-grade fever, sleep disturbance, appetite, pain in muscles, joints, bones (especially at night). These symptoms are harbingers of the imminent appearance of generalized rashes, that is, the beginning of the secondary period of syphilis.
Secondary period begins on average 2.5 months after infection and lasts in most cases 2-4 years. Its course is characterized by waves with alternating periods of manifestation (relapses) and periods of a latent state. From relapse to relapse, the rashes become less and less abundant, but larger, faded, prone to grouping, merging and vegetating. As the duration of the disease increases, the periods of latency lengthen. Syphilides of the secondary period are highly contagious, in general they are characterized by a benign course without scarring and atrophy, dull coloring, lack of subjective sensations, peripheral growth, true polymorphism (roseola, papules, less often - papulopustules). In the secondary period of syphilis, such peculiar manifestations as leukoderma (skin dyschromia) and alopecia (hair thinning) of a diffuse, small-focal or mixed nature (most often in the temporo-occipital regions) can also be observed.
The clinical picture of lesions of the skin and mucous membranes in early acquired syphilis is very diverse. Its manifestations must be differentiated from the symptoms of many skin diseases. If we consider that in early forms of syphilis the nervous system and internal organs can be affected, and the clinical picture of these lesions is not pathognomonic for syphilis, then it becomes clear how difficult the diagnostic task is facing doctors of various specialties. The likelihood of diagnostic errors will decrease if the rule is followed: any patient hospitalized in a hospital or undergoing outpatient treatment must undergo a serological examination for syphilis.
- How common is tertiary syphilis today?
- Cases of tertiary syphilis are still a casuistic rarity. However, we cannot forget about the possibility of developing manifestations of the tertiary period of the disease in untreated or insufficiently treated patients. A few years after the start of the epidemic rise in the incidence of early forms of syphilis, an increase in the registration of its later forms will inevitably follow.
- What is “malignant syphilis”?
- Malignant syphilis is a special, unfavorable course of the disease observed in immunocompromised patients (alcoholics, drug addicts, people with severe somatic diseases, HIV-infected people, etc.). It has the following features:

• The incubation period can be lengthened or shortened depending on the depth of changes in the immune system.
• The primary period is usually shortened to 3-4 weeks, chancre is prone to necrosis (gangrenization) and peripheral growth (phagedenization), regional adenitis and polyadenitis, as a rule, are not observed.
• The secondary period is characterized by the appearance of papulopustular syphilides, a tendency to ulceration of the elements, but treponemas are difficult to detect in them. There is a continuous recurrence of rashes without periods of latency. Sometimes, against the background of secondary syphilides, lumpy and gummous rashes characteristic of the tertiary period of the disease can be observed.
• Malignant syphilis often occurs with a violation of the general condition, intoxication, and fever.
• Nonspecific serological reactions may remain negative due to a sharp decrease in the production of specific antibodies (uncontrolled development of infection). During antibiotic therapy, serological reactions may become positive.

• their use is very convenient in outpatient settings,
• they are quite effective in early forms of syphilis,
• they are well purified and rarely cause allergic reactions.

Specific treatment prescribed to a patient with syphilis after diagnosis. The diagnosis is established on the basis of the clinical picture, detection of the causative agent of the disease (with appropriate clinical manifestations) and the results of a serological study (DSR, RIF and in most cases RIT). Specific diagnostic confirmation tests such as enzyme immunoassay (ELISA) and passive hemagglutination reaction (RPHA) can also be used.

Preventive treatment carried out to prevent syphilis for persons who have had sexual or close household contact with patients with infectious forms of syphilis. Preventive treatment is not prescribed to persons who have had sexual or close household contact with patients with tertiary, late latent, syphilis of internal organs or the nervous system. Preventive treatment is also not provided to persons who have had sexual contact with patients who are prescribed preventive treatment (i.e., second-contact contacts). When patients with syphilis are identified in a children's team, preventive treatment is prescribed to children in cases where close household contact with employees who have had manifestations of primary or secondary syphilis on the oral mucosa cannot be ruled out.

Preventative treatment performed on pregnant women who are sick or have had syphilis, and on children born to such mothers.

Trial treatment can be prescribed if there is a suspicion of specific damage to internal organs, the nervous system, sensory organs, or the musculoskeletal system, when it is not possible to confirm the diagnosis with convincing laboratory data, and the clinical picture does not exclude the possibility of a syphilitic infection.

Patients with gonorrhea with unidentified sources of infection are subject to preventive anti-syphilitic treatment if it is impossible to establish dispensary observation for them (homeless people, tramps, etc.). If such a patient has a permanent place of residence and work, then he is not subject to preventive treatment against syphilis, but after treatment for gonorrhea he should be under clinical and serological observation for 3 months.

Each patient with syphilis undergoes a thorough clinical and laboratory examination in the hospital. A study of cerebrospinal fluid for diagnostic purposes is carried out in patients with clinical symptoms of damage to the nervous system, as well as in latent and late forms of syphilis.

Before starting treatment, it is necessary to find out about the tolerability of penicillin (or other antibiotics) in the past and record this in the medical records. In addition, 30 minutes before the first injection of penicillin, as well as before each injection of durant penicillin preparations, 2 tablets of one of the antihistamines should be prescribed.

Treatment regimens for patients with syphilis

Preventive treatment. Preventive treatment is carried out for persons who have sexual or close household contact with patients with the early stages of syphilis, if no more than 2 months have passed since the contact.

Treatment is carried out on an outpatient basis with bicillins 1, 3, 5, in single doses of 1,200,000 units, 1,800,000 units and 1,500,000 units, respectively, 2 times a week, 4 injections per course. Benzathine penicillin (retarpen, extensillin) is administered once at a dose of 2,400,000 units intramuscularly in a two-step manner. Retarpen is dissolved in 5 ml of 0.25% solution of novocaine, water for injection, saline. Extensillin is dissolved in 8 ml of solvent and 1,200,000 units are injected into each buttock.

Preventive treatment of recipients who have received blood from patients with syphilis is carried out no more than 2 months after the transfusion with double administration of drugs of 2,400,000 units with an interval of 1 week.

In the hospital, treatment is carried out with sodium or potassium salt of penicillin - 400,000 units per injection 8 times a day (every 3 hours) for 14 days; per course 44,800,000 units. It is possible to use novocaine salt of penicillin, 600,000 units 2 times a day for 14 days; per course - 16,800,000 units.

Persons for whom 2 to 4 months have passed since contact with patients with syphlis undergo a double clinical and serological examination (with a study of CSR, RIT, RIF) with an interval of 2 months. If more than 4 months have passed since contact, a one-time clinical and serological examination is performed.

Treatment of patients with primary and secondary fresh syphilis carried out using one of the following methods: bicillin-1, 3, 5. Single dose - 1,200,000 units, 1,800,000 units, 1,500,000 units, respectively; number of injections - 7 (for primary seronegative syphilis), 8 (for primary seropositive), 10 (for secondary fresh syphilis). The first injection is carried out in an incomplete dose of 300,000 units; the second - in a full single dose, carried out every other day; subsequent injections are carried out 2 times a week.

Novocaine salt of benzylpenicillin is used, 600,000 units 2 times a day for 16 days; The course dose is 19,200,000 units.

Treatment is carried out with water-soluble penicillin, which is administered intramuscularly at 400,000 units every 3 hours for 14 days; course dose - 44,800,000 units (during the primary seronegative period of syphilis). For primary seropositive and secondary fresh syphilis, treatment lasts 16 days; on the 16th day, 3 hours after the end of penicillin therapy, bicillin-3 is administered once in a dose of 4,800,000 units (2,400,000 units intramuscularly in each buttock) or bicillin-5 in dose of 3,000,000 units.

For primary seronegative syphilis, benzathine penicillin preparations are administered intramuscularly once at a dose of 2,400,000 units. For primary seropositive and secondary fresh syphilis, retarpen or extencillin is administered at a dose of 2,400,000 units twice with an interval of 1 week.

Treatment of patients with secondary recurrent and latent early syphilisbicillin-1, 3, 5. For the first injection, a dose of 300,000 units is used; for subsequent injections, a single dose is 1,200,000 units, 1,800,000 units, 1,500,000 units, respectively. Injections are carried out 2 times a week, the number of injections is 14, regardless of which bicillin is used.

Novocaine salt of penicillin is used, 600,000 units 2 times a day for 28 days.

Treatment is carried out with water-soluble penicillin, 400,000 units 8 times a day for 28 days.

Patients with secondary recurrent and early latent syphilis receive 3 injections of extencillin, 2,400,000 units each, with an interval of 1 week.

When treating patients with secondary recurrent and latent early syphilis with retarpen, the first injection is carried out in a dose of 4,800,000 units (2,400,000 units in each buttock), the second and third injections - 2,400,000 units with an interval of 1 week.

Treatment is carried out with water-soluble penicillin (sodium salt) intramuscularly in single doses of 1,000,000 units (penicillin is diluted in 2 ml of saline or distilled water) 6 times a day for 28 days; course dose - 168,000,000 units).

For malignant syphlis, transfusion syphilis and early neurosyphilis, the latter method is preferable in combination with nonspecific and symptomatic therapy.

In cases where in patients with latent early syphlis, through confrontation, study of anamnesis and according to laboratory tests, the duration of the disease corresponding to primary seropositive or secondary fresh syphilis has been reliably established, treatment of these patients can be carried out according to the methods recommended for the treatment of these stages of syphilis.

It is advisable to combine specific treatment of patients with secondary recurrent and early latent syphilis with nonspecific therapy.

Principles of treatment of patients with syphilis with concomitant infections of the genitourinary tract. Patients with syphilis should be tested for HIV and other sexually transmitted infections.

If a patient with syphilis has gonorrhea, treatment is carried out with antibiotics that are active against both gonococcus and Treponema pallidum (penicillin, doxycycline, sumamed).

When combining early forms of syphilis and chlamydial infection, or syphilis, gonorrhea and chlamydial infection, treatment with sumamed (azithromycin) is recommended. Treatment is carried out for 14 days, the drug is administered 0.5 g once a day (or 0.25 g 2 times a day) 2 hours after meals or 1 hour before meals. On the first day of treatment, the dose of sumamed is 1.0 g, taken in one or two doses (morning and evening).

If trichomoniasis is detected in a patient, it is treated simultaneously with antisyphilitic therapy.

If HIV antibodies are detected in a patient, he is sent for further treatment and constant monitoring to the regional AIDS treatment center with appropriate recommendations regarding the treatment of syphilis.

If possible, patients with syphilis should be screened for other sexually transmitted infections of the urogenital tract, followed by treatment according to the diagnosis after completion of syphilis therapy. It is also possible to simultaneously treat concomitant infections with drugs that are highly effective against treponema pallidum.

Treatment of patients with latent late syphilis. Treatment begins with preparation of bioquinol 2 ml every other day until 12-14 ml of the drug is obtained, after which penicillin therapy is added at 400,000 units every 3 hours for 28 days. The total dose of bioquinol is adjusted to 40-50 ml. In this technique, bijoquinol can be replaced by bismoverol, which is used 1 ml every other day or 1.5 ml 2 times a week; per course 18-20 ml.

During penicillin therapy, it is advisable to use chymotrypsin 5 mg intramuscularly 2 times a day. Chymotrypsin promotes better penetration of the antibiotic into organs and tissues.

If there are contraindications to the administration of bismuth drugs, then treatment is carried out with two courses of penicillin of 400,000 units every 3 hours for 28 days. Before starting the first course, preparation is carried out for 10 days with erythromycin, tetracycline or oletethrin, 0.5 g four times a day. In the second year, instead of soluble penicillin, it is possible to use bicillins. Bicillin-1 is administered in a single dose of 1,200,000 units, bicillin-3 - in a dose of 1,800,000 units, bicillin-5 - in a dose of 1,500,000 units; injections 2 times a week; for a course of 7 injections.

Specific treatment of patients with late latent syphilis should be combined with the prescription of nonspecific drugs. Treatment of patients with latent unspecified syphilis is recommended to be carried out individually (similar to late or early latent syphilis).

Treatment of patients with visceral and tertiary syphilis. Treatment of patients with visceral syphilis should include, in addition to specific ones, also nonspecific and symptomatic drugs and be carried out under the supervision of a therapist.

Specific treatment of patients with visceral and tertiary syphilis is carried out according to the scheme of late latent syphilis with longer preparation with bioquinol (up to a dose of 20 ml). In the treatment of late syphilitic hepatitis, as well as specific lesions of the kidneys and urinary tract, bismuth preparations are not prescribed. In other cases, the issue of using bismuth is decided individually.

For syphilitic aortitis complicated by aortic aneurysm or aortic valve insufficiency, preparation with bioquinol should begin with a single dose of 1 ml (3 injections), followed by an increase to 1.5 ml (3 injections) and then to 2 ml. After receiving 25-30 ml of the drug, penicillin therapy is added. The latter begins with a single dose of 50,000 units every 3 hours. The single dose is increased every other day according to the following scheme: 50,000 - 100,000 - 200,000 - 400,000 units. The duration of penicillin therapy is 28 days. If the use of bismuth is contraindicated, preparation is carried out with erythromycin or oletethrin 0.5 g 4 times a day for 2 weeks. If there are contraindications to the prescription of bismuth drugs, treatment is carried out with two courses of penicillin of 400,000 units every 3 hours for 28 days (in the second course, from the very beginning, a single dose of penicillin is 400,000 units).

If clinical symptoms of the disease remain after a penicillin-bismuth course, it is advisable to prescribe an additional 2 courses of bismuth therapy, one of which is carried out with bijoquinol (40-50 ml per course), the other with bismoverol (16-20 ml per course).

Specific treatment of visceral syphilis is carried out under the control of the functional state of the affected organ (blood tests, urine tests, biochemical tests, indicators of the blood coagulation system, ECG, etc.).

The choice of treatment method for gummous lesions depends on the location of the gumma and the general condition of the patient. For tertiary syphilis with gumma localized on the skin, treatment is similar to late latent syphilis.

Treatment of patients with neurosyphilis. In early forms of neurosyphilis, treatment is carried out according to the following method: water-soluble penicillin (sodium salt) intramuscularly in single doses of 1,000,000 units 6 times a day for 28 days.

To increase the concentration of penicillin in the cerebrospinal fluid, it is advisable to use drugs that delay the removal of antibiotics from the body, in particular, probenecid 0.5 g 4 times a day, or etamide 1.05 g (3 tablets) 4 times a day for 10 days.

Patients with late neurosyphilis, with the exception of patients with optic nerve atrophy, are subject to treatment according to late latent syphilis regimens.

Each course of specific therapy must be supplemented with vitamins, tonics and stimulants. Treatment should be carried out under the supervision of a neurologist and ophthalmologist: the first two courses in a hospital (and for optic nerve atrophy - all 3 courses in a hospital).

For primary optic nerve atrophy, the first course of treatment begins with vitamin saturation:

taking vitamin A 33,000 IU 2 times a day in any of the forms listed below: dragees or retinol acetate tablets; oil solution of retinol acetate in capsules; tablets or oil solution of retinol palmitate;

taking a complex of vitamins in the form of a mixture in powder: ascorbic acid 0.15 g, nicotinic acid 0.05 g, glutamic acid 0.5 g, riboflavin (vitamin B 2) 0.025 g;

intramuscular injections of vitamins B 1 (thiamine chloride 5% - 2 ml daily No. 30, B 6 (pyridoxine 5% - 1 ml every other day No. 15) and B 12, 200 mcg daily No. 30;

taking calcium supplements (preferably calcium glycerophosphate) 0.1 g 3 times a day.

At the same time, penicillin therapy is started with small doses (50,000 units), with a further increase by 50,000 units every other day (50,000 - 100,000 - 150,000 - 200,000 units). Penicillin in a single dose of 200,000 units is used for a week, after which the single dose is increased to 400,000 units. The duration of penicillin therapy is 28 days.

Subsequently, 2 more courses of penicillin therapy are carried out in a single dose every 3 hours for 28 days. The interval between courses is 1 month.

In parallel with specific therapy, nonspecific, stimulating and vitamin therapy should be carried out in each course; systematic observation by an ophthalmologist is necessary.

Reserve methods of treating patients with syphilis. In case of intolerance to penicillin drugs, broad-spectrum antibiotics are used: erythromycin, tetracycline, oletethrin, doxycycline, sumamed.

For preventive treatment, erythromycin, tetracycline and oletethrin are used at 0.5 g 4 times a day; doxycycline capsules 0.1 g 3 times a day for 14 days.

For fresh forms of syphilis, these antibiotics in the same doses are used for 20 days in the primary period of syphilis, 25 days in the secondary fresh. For secondary recurrent and early latent syphilis, 2 courses of 30 days each of the named antibiotics in the indicated doses are recommended, the interval between courses is 2 weeks.

With simultaneous intolerance to penicillin, erythromycin and tetracyclines, treatment can be carried out with cefazolin (cefamizin). The drug is used intramuscularly at a dose of 1.0 g six times a day for 14 days for primary seronegative, 16 days for primary seropositive and secondary fresh syphilis, 28 days for secondary recurrent and latent early syphilis.

When treating fresh forms of syphilis, you can use sumamed (azithromycin) orally 0.25 g twice a day or 0.5 g once a day for 14 days.

For late latent syphilis, reserve antibiotics are used for 2-3 courses. The duration of antibiotic therapy is 28 days, the break between courses is 2 weeks.

Nonspecific therapy of patients with syphilis. Nonspecific therapy is indicated for latent, late forms of the disease, syphilis of the nervous system and internal organs, congenital syphilis, with concomitant pathologies, including alcoholism, with signs of a malignant course of the disease, with delayed negativity of serological reactions, serorelapses and seroresistance. It is advisable to prescribe nonspecific therapy for secondary recurrent and early latent syphilis, and, if indicated, for its fresh forms.

Methods of nonspecific therapy include: pyrotherapy, vitamin therapy, biogenic stimulants and agents affecting tissue metabolism (extracts of aloe, placenta, vitreous, splenin, asparkam, etc.), immunomodulators (decaris, methyluracil, sodium nucleinate, pyrroxan), UV reinfusion - irradiated autologous blood. Nonspecific therapy should be prescribed after a thorough examination of the patient, taking into account the indications and contraindications for a particular drug.

Pyrotherapy leads to increased heat production processes, improved conditions of blood and lymph circulation in the affected organs and tissues, activation of the histiocytic-reticular system, increased phagocytosis, enzymatic and secretory activity of the stomach and salivary glands. Among the pyrogenic drugs, pyrogenal and prodigiosan are the most tested and recommended.

Pyrogenal - a complex polysaccharide complex - is prescribed in the form of intramuscular injections into the upper outer quadrant of the buttock, at an initial dose of 5-10 mcg, with a gradual increase by 10-30 mcg per injection, reaching 120-150 mcg, depending on the body’s reaction. The drug is administered once every 2-3 days, for a total of 10-15 injections per course of treatment.

Prodigiosan - lipopolysaccharide, which has a similar effect on the body to pyrogenal, is administered intramuscularly 2 times a week in doses of 25 to 100 mcg; a total of 4-6 injections per course.

Biogenic stimulants (PhiBS for injection, suspension and placenta extract for injection, splenin, plasmol, vitreous body, polybiolin) are prescribed as subcutaneous injections of 1 ml daily for 10-20 days. Splenin is administered intramuscularly daily at 2 ml for 10 days, polybiolin is administered intramuscularly daily at 5 ml of solution (the contents of the bottle are 0.5 g - dissolved in 5 ml of 0.25-0.5% novocaine solution) for 10 days.

Vitamins WITH , groups IN , aevit used simultaneously with specific treatment throughout the entire course of treatment for patients with syphilis. Ascorbic acid is used 0.2 g 3 times a day, Aevit in capsules 1 capsule 3 times a day. Vitamins B 1, B 6, B 12 in the form of ampoule solutions are administered intramuscularly every other day, for a course of 10-15 injections. Individual patients with syphilis need to include adaptogenic drugs in complex therapy - pantocrine, Eleutherococcus extract, Rhodiola rosea, ginseng tincture, Schisandra tincture.

Immunocorrective therapy is usually prescribed in cases where there are signs of a malignant course of the disease, in the presence of concomitant diseases that develop against the background of immunosuppression (mucocutaneous candidiasis, chronic pyoderma, etc.), as well as in patients simultaneously suffering from chronic alcoholism. Immunocorrective therapy is recommended to be carried out under the control of an immunogram.

Levamisole (decaris) increases the functional activity of phagocytes and T-lymphocytes. The drug is prescribed at a dose of 150 mg daily for 3 days, followed by a break for 4 or 7 days, a total of 2-4 such cycles (under the control of the number of blood cells). Possible adverse reactions in the form of urticaria, nausea, vomiting, toxic effects on red blood cells and white blood cells.

Methyluracil accelerates cellular regeneration processes, stimulates cellular and humoral resistance factors. It is prescribed in cycles of 0.5 g 4 times a day for 10-14 days with 5-7 day breaks, a total of 2-3 cycles.

Nucleinate sodium increases the functional activity of immunocompetent cells, stimulates factors of nonspecific resistance of the body. The drug is prescribed in two-week cycles of 0.1 g 3 times a day with a week break.

Pyrroxane in the complex therapy of syphilis it is used mainly in persons suffering from chronic alcoholism. It has a detoxifying effect, relieves alcohol withdrawal symptoms, and improves the absorption of oxygen by tissues. It is used orally in tablets of 0.015 g 3 times a day, 2 cycles of 10 days, with a break of 7-10 days.

Taktivin And Thymalin - polypeptide preparations isolated from the thymus gland of cattle. In immunodeficiency states, these drugs normalize the quantitative and functional indicators of the T-immune system, the functional activity of hematopoietic stem cells, enhance phagocytosis, and normalize other indicators of cellular immunity. It is advisable to begin the introduction of immunomodulators on the 10-12-14th day of antibiotic therapy.

Taktivin is administered subcutaneously, 1 ml of a 0.01% solution once a day for 3 days in a row, then 2 times a week; for a course of 6-8 injections.

Timalin is administered intramuscularly at 10 mg (diluted in 1-2 ml of isotonic sodium chloride solution to obtain a uniform suspension) every other day; for a course of 6-8 injections.

Thymogen - synthetic peptide - glutamyltryptophan. It normalizes the number of T-helper cells and restores the ratio of immunoregulatory subpopulations of T-lymphocytes. Thymogen is administered intramuscularly at 100 mcg (dissolved in 1 ml of isotonic sodium chloride solution) 2 times a week; for a course of 5-8 injections.

Specific, prophylactic and preventive treatment of pregnant women

If early stages of syphilis are detected in pregnant women, treatment is carried out according to one of the methods outlined in the relevant sections of these recommendations.

When primary or secondary fresh syphilis is detected in pregnant women, specific treatment is carried out with penicillin 400,000 units every 3 hours for 14-16 days, when secondary recurrent or early latent syphilis is detected - in those single or daily doses for 28 days. When latent late syphilis is diagnosed, treatment is carried out with three courses of penicillin, 67,200,000 units per course, in single doses of 400,000 units every 3 hours, with an interval between courses of 7-10 days.

Treatment pregnant women with retarpen or extencillin is given in accordance with the diagnosis in the doses indicated above, but at least two injections are given. Preventive treatment for pregnant women is carried out with 2-3 antibiotic injections of 2,400,000 units at an interval of 1 week.

To prevent congenital syphilis, a two-time serological examination of pregnant women is recommended: in the first half of pregnancy (when visiting an obstetrician-gynecologist to register for pregnancy) and in the second half (in the 6-7th month, but not later than maternity leave). In unfavorable epidemiological conditions, by decision of the health authorities, a three-time serological examination of pregnant women for syphilis may be introduced. The third examination is carried out immediately before birth. If the DCS results are positive, the differential diagnosis is carried out using RIT, RIF and other specific serological reactions. In case of negative results of these tests, the pregnant woman should be under clinical and serological control with a monthly study of CSR, RIT, RIF before birth and for 3 months after it.

In exceptional cases, in the absence of the possibility of studying RIT and RIF or other specific seroreactions, in pregnant women with a sharply positive SSR, the SSR study is repeated, and if its result is strongly positive, a diagnosis of latent syphilis is made. If there are repeated weakly positive DSR results, the pregnant woman is subject to careful clinical and serological monitoring over time to differentiate biologically false-positive DSR results caused by pregnancy.

Women who, after full treatment, have persistent negativity of CSR (negative results for at least a year before pregnancy) are not subject to preventive treatment during pregnancy. An exception may be women with continued sharp positivity of RIT and/or RIF without a tendency to decrease.

For women who have had fluctuations in their ESR positivity (from negative to positive results) during the year before pregnancy, or who have remained positive in their ESR, preventive treatment during pregnancy is recommended.

Women who have received preventive antisyphilitic treatment are not subject to preventive treatment during pregnancy.

Preventative treatment pregnant women carried out using one of the following methods:

method No. 1. Water-soluble penicillin is administered at a dose of 400,000 units 8 times a day for 14 days;

method No. 2. Novocaine salt of benzylpenicillin is administered 600,000 units 2 times a day for 14 days;

method No. 3. Bicillins-1, 3, 5 are administered at a dose of 1,200,000 units, 1,800,000 units, 1,500,000 units, respectively, 2 times a week; for a course of 7 injections.

If specific treatment is carried out in the first months of pregnancy, then preventive treatment should be started no later than 6-7 months. If specific treatment is carried out in late pregnancy, then preventive treatment follows it without interruption.

Preventive treatment of pregnant women is carried out in accordance with these recommendations (see section “Preventive treatment”).

When treating pregnant women with intolerance to penicillin drugs, it is not advisable to use erythromycin, since, although it has a good clinical effect in the mother, it does not sufficiently penetrate the placenta and does not prevent the occurrence of congenital syphilis in the child. Tetracycline drugs prevent congenital syphilis, but are deposited in the bone tissue and teeth of the fetus.

Taking this into account, it is advisable to use oxacillin in pregnant women, which is administered intramuscularly at 1,000,000 units with an interval of 6 hours, 4 times a day, for 14 or 28 days, depending on the stage of the disease.

Treatment and prevention of syphilis in children. Preventive, prophylactic and specific treatment of children is carried out with penicillin preparations. For children under 2 years of age, sodium and novocaine salts of penicillin are used; for children over 2 years of age, bicillin is also used. The daily dose of penicillin (sodium and novocaine salts) is calculated at the rate of 100,000 units/kg for children under 6 months of age, 75,000 units/kg for children aged 6 months to 1 year, 50,000 units/kg for children over 1 year of age. The daily dose is divided into 6 equal single doses for water-soluble penicillin and 2 doses for its novocaine salt.

Bicillins 1, 3 or 5, 300,000 units are administered once a day. If well tolerated, after several injections you can switch to administering 600,000 units once every 2 days (300,000 units in each buttock).

The duration of preventive treatment is 2 weeks; preventive - from 2 to 4 weeks; specific, for early congenital syphilis - 4 weeks; for late congenital - 4 weeks of antibiotic therapy in combination with bismuth drugs. The duration of treatment for acquired syphilis in children with fresh forms of the disease is 2 weeks, with secondary recurrent and latent early forms - 4 weeks.

If you are intolerant to penicillin, you can use oxacillin and ampicillin.

Oxacillin prescribed intramuscularly in the following daily doses: newborns - 20-40 mg/kg body weight, children under 3 months - 200 mg/kg, from 3 months to 2 years - 1.0 g per day, from 2 years and older - 2.0 g per day.

It is possible to use oxacillin orally, 1 hour before meals or 2-3 hours after it in the following daily doses: newborns - 90-150 mg/kg of body weight, up to 3 months - 200 mg/kg, from 3 months to 2 years - 1.0 g per day, from 2 years and older - 2.0 g per day.

Ampicillin sodium salt used intramuscularly in the following doses: newborns - 100 mg/kg, other children 50 mg/kg, maximum - 2.0 g per day. The daily dose is divided into 4-6 injections.

Ampicillin tablets are used orally in the same doses, regardless of food intake. The daily dose is divided into 4-6 doses.

In case of intolerance to semisynthetic penicillins, it is possible to use erythromycin for children aged 1 to 3 years - at a dose of 0.4 g per day, 3-6 years - 0.5-0.7 g, 6-8 years - 0.75 g, 8-12 years - up to 1.0 g per day. The drug is given in equal doses 4-6 times a day.

To prevent allergic reactions, antihistamines and calcium supplements should be prescribed before and during treatment. On days 2-3 of treatment and at the end of the course, blood should be tested for CSR.

Preventive treatment children . The question of carrying out preventive treatment is raised in cases where the possibility of infection of children through close household or sexual contact with patients with infectious forms of syphilis and early latent syphilis has been established.

Taking into account the peculiarities of caring for children and their communication with each other, treatment is usually indicated for children under 3 years of age. For older children, the issue of treatment is decided individually, taking into account the form of syphilis, the location of the rash and the degree of contact with the child.

Preventive treatment is carried out if no more than 2 months have passed since the last contact with the patient. For a longer period, the child must undergo a complete clinical and serological (DAC, RIT, RIF) examination.

If there is no evidence of syphilis, treatment is not prescribed, and after 4 months a re-examination is carried out, after which observation is stopped.

In cases of blood transfusion to children from donors with syphilis, preventive treatment is prescribed for up to 3 months after the transfusion.

Preventive treatment children . Children born to mothers with syphilis are not subject to clinical and serological examination and observation at a dermatovenerological dispensary in cases where the mother, after full specific treatment, has had a persistent negativity of the DSR before pregnancy (negative DSR results within a year).

The remaining children born to mothers who had syphilis or were in close contact during pregnancy with patients with infectious forms of syphilis should undergo a clinical and serological examination in the first months of life (preferably at the age of 2.5-3 months). Mandatory components of the examination are: consultation with a pediatrician, dermatovenereologist, neurologist, otolaryngologist, ophthalmologist, blood tests (KSR, RIF, RIT), radiography of the bones of the extremities. In the presence of clinical neurological changes, a spinal puncture is indicated.

Children whose mothers were subject to preventive treatment during pregnancy and received it (including mothers with seroresistance), in the absence of clinical, serological and radiological signs of the disease in the children, are not subject to preventive treatment, but remain under the supervision of a dermatovenerological dispensary for 1 year.

Children whose mothers were subject to preventive treatment but did not receive it, as well as children whose mothers received inadequate syphilitic treatment, are subject to preventive treatment for 2 weeks.

Children born from untreated mothers with syphilis are subject to preventive treatment according to the scheme of early congenital syphilis lasting 4 weeks, even if the children do not have clinical, serological and radiological signs of the disease.

If the results of the examination of a child born to a mother with syphilis are questionable, the question of treatment is decided individually, taking into account the medical history, the age of the child and the amount of treatment received by the mother.

If a child is examined for the first time over the age of 1 year, then if the examination results are negative, he is not treated. In doubtful cases, penicillin therapy for 2 weeks is recommended.

Specific treatment children , sick congenital syphilis . Treatment of children with early congenital syphilis is carried out with sodium or novocaine salt of benzylpenicillin in a hospital setting (single and daily doses are indicated above). The duration of treatment is 28 days.

Treatment of children with late congenital syphilis is carried out with penicillin in combination with bismuth, similar to late latent syphilis in adults. Treatment begins with bioquinol, administered intramuscularly 2 times a week, in an age-specific dosage. If there are contraindications, bijoquinol can be replaced with bismoverol.

Upon reaching 1/4 of the course dose of bioquinol, its administration is interrupted and switched to injections of soluble penicillin or its novocaine salt. The daily dose is calculated based on the child's body weight. The duration of penicillin therapy is 28 days. At the end of the antibiotic administration, treatment with bismuth preparations is continued until the course dose is reached.

If you are intolerant to penicillin drugs, oxacillin, ampicillin or erythromycin are prescribed. Along with antibiotic therapy, it is recommended to take nystatin and antihistamines.

Single and course doses of bismuth preparations in the treatment of children with congenital syphilis.

Age up to 3 years - bioquinol (ml) - single dose 0.5 - 1.0, course dose 12.0-15.0; bismoverol (ml) - single dose 0.2-0.4, course dose 4.0-4.8.

Age from 3 to 5 years - bioquinol (ml) - single dose 1.0-1.5, course dose 15.5-20.0; bismoverol - 0.4-0.6 and 6.0-8.0, respectively.

Age from 6 to 10 years - bioquinol (ml) - 1.0-2.0 and 20.0-25.0; bismoverol - 0.4-0.8 and 8.0-10.0.

Age from 11 to 15 years - bioquinol (ml) - 1.0-2.0 and 25.0-30.0; bismoverol - 0.6-0.8 and 10.0-12.0.

Treatment acquired syphilis at children . Treatment is carried out with penicillin preparations according to the principle of treating syphilis in adults. The daily dose of antibiotic is calculated as indicated. The duration of therapy for primary and secondary fresh syphilis is 14 days, secondary recurrent and latent early syphilis is 28 days. For late latent acquired syphilis, treatment is carried out in the same way as for late congenital syphilis.

The condition for the recovery of patients is early and skillfully carried out, strictly individual treatment, taking into account the tolerability of drugs. A combination of specific and nonspecific therapy is advisable; in addition, stimulating therapy is used. One of the oldest antisyphilitic drugs are mercury preparations, the treatment methods of which were described by Fracastoro back in the 16th century. At the beginning of the 19th century, iodine preparations began to be used to treat syphilis, and in the 20th century - arsenic and bismuth.

Currently, antibiotics, bismuth and iodine preparations are mainly used.

Penicillin group drugs. Benzylpencillin, oxacillin, doxacillin, ampicillin, carbenicillin. These drugs are well absorbed into the blood and are quickly eliminated. Therefore, in order to constantly maintain the concentration of the antibiotic in the blood, the drug is administered intramuscularly every 3 hours. Long-acting penicillin preparations are used: bicillin - a single dose in adults of 1,200,000 units is administered for 6 days. A single dose of bicillin-1 is administered in half the amount separately into both buttocks in the form of a suspension in a sterile dose or saline solution.

Bicillin - administered 100,000 units once every 3-4 days. Bicillin-5 is administered 3,000,000 units once every 5 days.

30 minutes before the first injection, antihistamines (diphenhydramine, diazolin, suprastin, tavegil, pipolfen) are prescribed.

Erythromycin 0.5 g 4 times a day half an hour before meals or 1-1.5 hours after meals. The total dose of the drug is determined by the doctor.

Tetracyclines should be taken with or after meals, 0.5 g 4 times. Long-acting tetracyclines include doxacillin, which is taken depending on the stage of the disease.

Oletetrin 0.5 g 4 times a day. The total dose is determined by the doctor.

Patients with syphilis are not prescribed all of the above antibiotics; those that are suitable for the patient are selected, taking into account their tolerability and individuality. Antibiotics should not be used by patients with syphilis, asthma, urticaria, hay fever and other allergic conditions.

Bicillin should not be prescribed to patients with hypertension, who have had a myocardial infarction, diseases of the gastrointestinal tract, diseases of the endocrine glands, hematopoietic system, tuberculosis. It is not recommended for weakened patients, persons over 55 years of age and children to use a single dose of more than 1,200,000 units. I would like to describe in more detail the new generation of antibiotics and antiseptics.

Doxilan blocks protein synthesis in the cells of sensitive microbes. Used internally. For adults and children weighing more than 50 kg, on the first day, 200 mg in 1-2 doses, then 100-200 mg per day. At least 10 days.

Muramistin- antiseptic. Increases the permeability of the cell membrane of microorganisms and leads to cytolysis. In addition, it also affects fungi and stimulates a nonspecific immune response. It is used topically for individual prophylaxis by injecting 2-5 ml of solution into the urethra 2-3 times; on the day after sexual intercourse, you must urinate, wash your hands and genitals, and spray the skin of the pubic area, thighs, and external genitalia with a stream of solution. After insertion into the urethra, do not urinate for 2 hours. For women, in addition to the urethra, up to 5-10 ml is also injected into the vagina.

Retarpen- antibacterial agent. Blocks the synthesis of the cell membrane of microbes, causing their death. It is used intramuscularly, for children under 12 years old - 1.2 million IU every 2-4 weeks, for adults - 2.4 million IU once a week. For primary seropositive and secondary fresh syphilis - 2.4 million IU twice, with an interval of 1 week. For secondary recurrent and latent early syphilis, the first injection is made in a dose of 4.8 million IU (2.4 million IU in each buttock), the second and third injections - 2.4 million IU each with an interval of 1 week, for newborns and young children age - 1.2 million IU.

Rovamycin- macrolide antibiotic. Stops protein synthesis. For adults, the daily dose for oral administration is 6-9 million IU, for children weighing more than 20 kg - 1.5 million IU/10 kg per day in 2-3 doses. Children weighing up to 10 kg - 2-4 sachets of granules of 0.375 million IU per day, 1-20 kg - 2-4 sachets of 0.75 million IU, over 20 kg - 2-4 sachets of 1.5 million IU. Prescribed intravenously only to adults. The contents of the bottle are dissolved in 4 ml of water for injection and administered over 1 hour in 100 ml of 5% glucose.

Cephobid- 3rd generation cephalosporins. It is used intramuscularly, intravenously. Adults - 2-4 g/day, children - 50-200 mg/kg body weight, the dose is administered in 2 doses (every 12 hours). Adults should avoid drinking alcohol during treatment.

Cefrivid. Intramuscularly (dissolved in 2-2.5 ml of water for injection or 0.25-0.5% procaine solution), intravenous drip (in 5% glucose solution, 0.9% NaCe solution). Prescribe 1 g - 2-4 times a day for 7-10 days. The maximum dose is 6 g. For children, 20-40 mg/kg, for severe infections - up to 100 mg/kg per day.

Cefotaxime. Intravenously, intramuscularly, 1-2 g 2 times a day (maximum daily dose - 12 g), for newborns and children - 0.005-0.1 g/p per day.

Extensillin intramuscularly deeply, dissolving the powder in water for injection. For the treatment of syphilis - every 8 days, 2,400,000 units. Injections are repeated 2-3 times.

Unidox Solutab. Blocks ribosomal polymerase and inhibits protein synthesis in microorganisms. It is used orally during meals; the tablet can be swallowed whole or diluted in water in the form of syrup (20 ml) or suspension (100 ml).

For adults and children weighing no more than 50 kg, start with 200 mg on the first day in one or two doses, then 100 mg once daily, for 10 days in severe cases - up to 300 mg. Children over 8 years old weighing less than 50 kg - on the first day at the rate of 4 mg/kg in one dose, then 2 mg/kg once daily. In severe cases - up to 4 mg/kg per day during the entire course of treatment.

Cannot be combined with penicillin and cephalosporins and drugs containing metals (antacids, iron-containing drugs), due to their ability to bind tetracyclines with the formation of inactive chelites.

For patients with impaired skin function, a reduced dose is used. When introduced into the body, the drug is carried by the bloodstream, deposited and retained for a long time in the internal organs, causing irritation of their nerve receptor zones.

The most popular drug is bioquinol. It needs to be warmed and shaken before use. Administer at the rate of 1 ml per 1 day, for 3 days. Course 40-50 ml IV and IM.

Bismoverol- a combination preparation of bismuth. Apply 1 ml every other day intramuscularly. The course dose is 16-20 ml. Complications are possible after bismuth preparations: the presence of bismuth anemia, nephropathy, stomatitis, anemia, jaundice.

Iodine preparations are most often used in the form of potassium iodide; sodium - 2-3 tbsp. l. after meals, washed down with milk.

Tincture of iodine used in increasing doses - from 50 to 60 drops in milk 3 times a day after meals. Lugol's solution - rarely.

Sayodin- 1-2 tablets 3 times a day after meals. The tablets must be chewed before taking.

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Nonspecific therapy of patients with syphilis

In addition to the specific drugs listed above, patients are also prescribed nonspecific treatment. This applies to patients with latent, late forms of the disease (neurovyscerosyphilis, congenital syphilis). Nonspecific therapy is prescribed to patients with infectious forms of syphilis.

These methods include pyrotherapy, vitamin therapy, ultraviolet irradiation, injections of biogenic stimulants (aloe extract, placenta, vitreous), immunomodulators (levamisole, diucioron, methyluracil, pyrroxane).

Pyrotherapy- a method that enhances heat production, improves blood and lymph circulation in affected organs and tissues, and enhances phagocytosis.

Pyrogenal— intramuscularly, the initial dose is up to 50-100 MTD, then it is increased. Administered every 2-3 days, 10-15 injections. After administration, body temperature rises within 1-2 hours and lasts up to 10-15 hours.

Prodigiozan. The dose is selected individually, administered 2 times a week, in increasing doses from 25 kol/kg.

Sulfozine- administered intramuscularly, from 0.5-2 ml adding 2 ml to 7-8 ml.

Immunotherapy. It is prescribed to patients with a malignant course of the disease, with latent forms of syphilis, and the presence of concomitant pathology. Biogenic stimulants: aloe extract, placenta, vitreous body. Prescribe s/c 1.0 for 15-20 days.

Levamisole. Prescribed in cycles of 150 mg for 3 days with weekly breaks, a total of 2-3 cycles.

Methyluracil- 0.5 g 4 times a day for 2 weeks, then after a 5-7-day break, repeat the dose.

Diuciphone 0.1 g 3 times a day for 6 days. Prescribe 2-3 cycles. You can administer 0.4 ml intravenously every other day.

Pyrroxane- detoxifying agent 0.0015×3 times in a 10-day cycle. Vitamins C, group B are mandatory as an antisyphilitic treatment for pregnant women and children.

Other nonspecific drugs are also prescribed: potassium orotate, pantocrine, eleutherococcus extract. It is not advisable to carry out external therapy in the presence of highly effective methods. It is resorted to only in isolated cases.

Local treatment comes down to the hygienic maintenance of affected areas. If the patient has ulcerative chancre with an infiltrate at the base, warm baths, lotions with a solution of benzylpenicillin in dimexide, and application of Acemin, yellow, mercury, and heparin ointments can be prescribed. To speed up the regeneration of weeping papules on the genitals and near the anus - powder from an application in half with talc, ointments with antibiotics, for long-term non-healing gummoid ulcers, 3-5 - 10% mercury and mercury-bismuth ointments are prescribed, 1-3% - erythromycin, 5% levorin, 5-10% syntomycin, mercury patch, local baths.

If there are rashes in the oral cavity, rinse with solutions of furacillin (1:10000), 2% boric acid or 2% gramicidin.

In people of retirement age or with varicose veins, gumma on the legs develop torpidly. Prescribe dressings with powdered sugar or a dressing with zinc-gelatin ointment according to Keifer for several weeks. Personal hygiene is the prevention of sexually transmitted diseases.

For men (after intercourse):

1. The visitor washes his hands, releases urine, and washes the penis, scrotum, thighs and perineum with warm water and soap.
2. Wiping the same areas with a cotton swab moistened with a solution of sublimate 1:1000.
3. A 2-3% solution of protargol is injected into the urethra using an eye pipette; 0.05% solution of hibitan, do not urinate for 2-3 hours.

For women:

1. The visitor washes her hands, releases urine, and washes her genitals, thighs, and perineum with warm water and soap.
2. Treatment of the same organs with a solution of sublimate 1:1000.
3. Douching the vagina with a solution of potassium permanganate (1:6000) with the introduction of a 1-2% silver preparation into the urethra. Lubricating the cervix and vaginal mucosa with the same solution. You can administer a 0.05% aqueous solution of hibitan.

Personal prevention can be carried out independently by a person who fears contracting sexually transmitted diseases as a result of casual sexual intercourse. We must not forget about regular condoms. And if it is not possible to carry out the above preventive measures, it is recommended to douche the genitals, urethra and vagina in women with a strong saline solution.