Ceftriaxone Therapy for Syphilis: Report from the Emerging Infections Network

Alternatives to penicillin for the treatment of syphilis continue to be sought [1]. The Centers for Disease Control and Prevention (CDC) currently recommend that tetracyclines be used when penicillin injections are contraindicated [2]. Highdose amoxicillin [3] and azithromycin [4] have both been recently studied. The third-generation cephalosporin ceftriaxone is active in vitro against Treponema pallidum [5]. Small-scale studies of patients with syphilis have suggested that this agent has clinical efficacy [6–8]. However, there is currently no generally accepted or recommended dose or dosing schedule for this use of ceftriaxone. During a review of literature on syphilis treatment for the 1998 revision of the CDC Sexually Transmitted Diseases Treatment Guidelines, questions were raised regarding the frequency of ceftriaxone use for the treatment of syphilis in the United States. To address this issue, we enlisted the use of the Infectious Diseases Society of America Emerging Infections Network (EIN), a cooperative agreement program funded by the CDC. In May 1998, the EIN queried 444 infectious diseases consultants who care for adult patients about their use of ceftriaxone for the treatment of patients with early syphilis. Respondents included EIN members from all parts of the continental United States.