Treatment of syphilis

Treatment of syphilis is carried out depending on the stage of the disease and the individual characteristics of the patient's body by one of the three options (schemes with the addition 1968): 1) the combined treatment with penicillin (emmanouilidou) with bismuth; 2) repeated courses one-penicillin (emmanouilidou) and in combination with non-specific therapy; 3) combined treatment with bicillin with bismuth.
1. In primary seronegative syphilis spend 2 courses of treatment at the rate of 100 000 IU soluble penicillin or economically on 1 kg of patient's weight, but not less than 6 000 000 UNITS on the course followed by the application of one of bismuth preparations (biogenol 2 ml a day intramuscularly at the rate of 40-50 ml or bismoverol 1.5 ml, 2 times a week, at a rate of 16 to 20 ml).
In primary syphilis seropositive spend four of these penicillin-bismuth rate the rate of 120 000 UNITS of penicillin on 1 kg of patient's weight, but not less than 7 200 000 f E at the course.
In secondary fresh syphilis spend 5 courses in the same doses as in primary seropositive. In secondary recurrent, serological and late forms of syphilis spend 6 courses of the same combined treatment based 140 000 UNITS of penicillin on 1 kg of patient's weight, but not less than 8 400 000 IU per course.
Treatment courses are held with monthly intervals, bismuth preparations should be changed. Patients early contagious forms of syphilis necessarily hospitalized. The first course of treatment is carried out in the hospital soluble penicillin.
2. Syphilis patients older than 50 years and suffering simultaneously kidney disease or tuberculosis recommend treating one penicillin without bismuth. In primary seronegative syphilis teach 3 courses of treatment, if the primary seropositive and secondary fresh - 5 courses in secondary recurrent, latent, tertiary and other later forms of syphilis - 8 courses. Course doses expect, like in the combined treatment; breaks between courses 2-3 weeks. When later forms of syphilis is recommended before treatment with penicillin, and in the intervals between courses assign iodine preparations. When serological reactions after 3 courses of treatment done joins non-specific therapy (autohemotherapy, injection of the extract of aloe Vera, kurortnaja, blood transfusion, pyrotherapy, subcutaneous injection of oxygen).
3. Treatment repository (long-acting) drugs penicillin - bicillin 1 and bicillin-3 - only valid on repeated courses, course of usual dosage (6 000 000, 7 200 000 or 8 400 000 UNITS depending on the stage of syphilis). Bicillin enter 1 200 000 IU every 4 to 5 days, or 2 400 000 IU every 9 days.
Breaks between courses 2-3 weeks.
The number of courses: when you initially seronegative syphilis - 2, primary seropositive - 3, secondary fresh - 4, secondary relapsing - 5. Treatment with bicillin in combination with bismuth recommended in the treatment of late forms of syphilis, seroresistance syphilis. Dose bicillin 140 000 UNITS per 1 kg of weight; teach five courses of treatment interruptions between them is one month.
Pregnant women, sick with syphilis treatment in accordance with the weight of the patient and the stage of disease. Pregnant with "unknown" syphilis treatment by regimen secondary recurrent syphilis. Pregnant women who had previously syphilis and treated fairly, but the term is not removed from the register, subject to treatment during each pregnancy. Pregnant removed from the register, receive treatment only during the first pregnancy occurred after removal from the register.
Preventive (preventive) treatment in cases where the possibility of infection with syphilis and assume that the subject is in the incubation period, and all who were in close household contact with sick with contagious forms, including children. It can be limited to one course of penicillin (economically) at the rate of 100 000 UNITS per 1 kg of weight.
Treatment of syphilis must be conducted with strict adherence to the above rules. Treatment of insufficient doses of drugs or stretched in terms of harm to patients: you experience a relapse of the disease with severe lesions of internal organs, nervous system, inflammation, and paralysis of the nerves, and in later stages tabes); persistent positive serological test (seroresistance).
The nurse should monitor the timely referral in the clinic and the observance of their terms of subsequent treatment.
After treatment, patients should remain under supervision of the doctor: when you initially seronegative - 2 years, when all other forms - 5 years. Inspection is carried out the clinical and serological. Upon expiration of one year after the treatment the patient should undertake a study of the cerebrospinal fluid.
Personal prevention. You cannot engage in casual sex. We recommend that you immediately after sexual intercourse thoroughly wash the genitals and the adjacent areas of the body with warm water and soap. In case of suspected infection with syphilis should refer to paragraph protivoanemicescoe assistance or to the nearest medical facility, where they washed the urethra solution of potassium permanganate, buried in the urethra solution of protargol and texture in the skin 33% calomel mercury (mercury monochloride, lanolin, petrolatum equally).