Bibliographic information
GuidelineUpdated recommendations for the treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum (syphilis) and new recommendations on syphilis testing and partner services.
Year of Publication2024
Issuing InstitutionWorld Health Organization
Recommendation
Updated
Late syphilis (late latent and tertiary syphilis of more than two years’ duration without evidence of treponemal infection) or unknown duration in pregnant women. If benzathine penicillin is not available, WHO suggests:
- procaine penicillin 1.2 million units intramuscularly once daily for 20 days.
In rare situations when benzathine or procaine penicillin cannot be used (e.g. due to confirmed penicillin allergy, which occurs in less than 3% of the population, and where penicillin desensitization is not possible) or are not available (e.g. due to stock-outs), WHO suggests using, with caution and enhanced follow-up:
- erythromycin 500 mg orally four times daily for 30 days.
Recommended in favor
Conditional
Certainty of evidence
Very low
Notes and Remarks
Remarks
- Although erythromycin treats the pregnant woman, it does not cross theplacental barrier completely and as a result the fetus is not treated. It istherefore necessary to treat the newborn infant soon after delivery (see therecommendations in the WHO guidelines referring to congenital syphilis). a
- Doxycycline is contraindicated during pregnancy.