Short-time, high-dosage penicillin infusion therapy of syphilis: an alternative to recommended regimens?

The optimal dosage and duration of penicillin treatment for the various stages of syphilis are not known. We present data on 20 patients with syphilis (primary, secondary or latent) treated with high-dose, short-time penicillin infusion therapy. Patients were given 10 MIU of penicillin G intravenously every 6 h up to a total dose of 90 MIU within 48 h. No adverse reactions were registered but 9 patients showed a Herxheimer reaction. Four patients were lost to follow-up and the remaining 16 were serologically and clinically followed for mean 18.5 months (range 3-36). During this period, the Wassermann reaction turned negative for 12 patients and was reduced more than fourfold for the rest, with one exception. None of the patients showed clinical signs of active syphilis following treatment. The cerebrospinal fluid penicillin concentration was measured in one patient during treatment and found to be much higher than the minimally treponemacidal concentration generally recommended. The treatment modality is reviewed and discussed and it may provide an alternative to conventional treatment regimens of early syphilis.