Review of current evidence and comparison of guidelines for effective syphilis treatment in Europe

• Published in: International Journal of STD & AIDS Vol. 15; no. 2; pp. 73 - 88
• Main Authors: PARKES, R, RENTON, A, MEHEUS, A, LAUKAMM-JOSTEN, U
• Format: Book Review Journal Article
• Language: English
• Published: London, England SAGE Publications 01.02.2004; Royal Society of Medicine Press; Sage Publications Ltd
• Subjects: AIDS/HIV; Bacterial diseases; Bacterial diseases of the genital system; Biological and medical sciences; Epidemiology. Vaccinations; Europe; Evidence-Based Medicine; General aspects; Human bacterial diseases; Humans; Infectious diseases; Medical sciences; Penicillins - administration & dosage; Practice Guidelines as Topic; Russia; Syphilis - pathology; Syphilis - prevention & control; Treponema pallidum; United States; Europe; United States; Russia; Human; Infection; Medicine; Sexually transmitted disease; Treatment; Spirochaetosis; Syphilis; Bacteriosis; Comparative study; Recommendation; Bibliographic review; Treponematosis
• ISSN: 0956-4624; 1758-1052
• DOI: 10.1258/095646204322764253

Ever since syphilis was first described its treatment has caused controversy. Despite Fracastoro's claim, the first effective cure for syphilis (Treponema pallidum subsp pallidum) was penicillin, which became available in the 1940s. Internationally there is now a broad consensus about the most effective therapies for syphilis. However, differences still remain around many details of treatment and the evidence base is not complete. In an attempt to rationalize treatment strategies, guidelines are regularly produced by different countries, regions and by the World Health Organization (WHO) worldwide. European guidelines were recently elaborated as a consensus document based on the Austrian, Dutch, German, Russian and UK national guidelines; they were approved by the European branch of the International Union against Sexually Transmitted Infections (IUSTI) and the Regional Office for Europe of the WHO. The purpose of this paper is to compare the most recent European, UK, and Russian guidelines, to include the US Centers for Disease Control (CDC) guidelines and to highlight differences in recommended treatments between them. The paper outlines the evidence and current thought that supports these differences, by consolidating information summarized in the guidelines and the many excellent review articles addressing the management of syphilis. The background section presents an overview of why differences in treatment recommendations exist. The body of the paper compares recommended treatments for different stages of disease and clinical contexts. Recommendations from the different guidelines have been presented together in tabular form to facilitate comparison. While precise definitions of the different stages of syphilis infection are somewhat arbitrary and have always varied, a detailed discussion of this is beyond the remit of this paper. Where the different guidelines use different definitions for stage of infection these are noted but the treatment of each stage of syphilis is presented as defined by the individual guidelines. For information on the diagnostic criteria for each stage of disease the reader should refer to the original guidelines.