Preventive Regimen
Indication	First Choice	Alternative	Comments/Special Issues
Primary Prophylaxis	N/A	N/A	Primary Prophylaxis Indicated for: N/A Criteria for Discontinuing Primary Prophylaxis: N/A Criteria for Restarting Primary Prophylaxis: N/A
Secondary Prophylaxis	N/A	N/A	Secondary Prophylaxis Indicated: N/A Criteria For Discontinuing Secondary Prophylaxis: N/A Criteria For Restarting Secondary Prophylaxis: N/A
Treatment	Congenital Proven or Highly Probable Disease: Aqueous crystalline penicillin G 100,000–150,000 units/kg body weight per day, administered as 50,000 units/kg body weight per dose IV every 12 hours for the first 7 days of life, and then every 8 hours for 10 days If diagnosed after 1 month of age, aqueous penicillin G 200,000–300,000 unit/kg body weight per day, administered as 50,000 units/kg body weight per dose IV every 4–6 hours (maximum 18–24 million units per day) for 10 days Possible Disease: Treatment options are influenced by several factors, including maternal treatment, titer, and response to therapy; and infant physical exam, titer, and test results. Scenarios that include variations of these factors are described and treatment recommendations are provided in detail on pages 36–37 of the Centers for Disease Control STD Treatment Guidelines, 2010. Acquired: Early Stage (Primary, Secondary, Early Latent): Benzathine penicillin 50,000 units/kg body weight (maximum 2.4 million units) IM for 1 dose Late Latent: Benzathine penicillin 50,000 units/kg body weight (maximum 2.4 million units) IM once weekly for 3 doses Neurosyphilis (Including Ocular): Aqueous penicillin G 200,000– 300,000 units/kg body weight per day administered as 50,000 units/kg body weight per dose IV every 4–6 hours (maximum 18–24 million units per day) for 10–14 days	Congenital Proven or Highly Probable Disease (Less Desirable if CNS Involvement): Procaine penicillin G 50,000 units/kg body weight IM once daily for 10 days Possible Disease: Treatment options are influenced by several factors, including maternal treatment, titer, and response to therapy; and infant physical exam, titer, and test results. Scenarios that include variations of these factors are described and treatment recommendations are provided in detail on pages 36–37 of the Centers for Disease Control STD Treatment Guidelines, 2010.	For treatment of congenital syphilis, repeat the entire course of treatment if >1 day of treatment is missed. Examinations and serologic testing for children with congenital syphilis should occur every 2–3 months until the test becomes non-reactive or there is a fourfold decrease in titer. Children with increasing titers or persistently positive titers (even if low levels) at ages 6–12 months should be evaluated and considered for retreatment. In the setting of maternal and possible infant HIV infection, the more conservative choices among scenario-specific treatment options may be preferable. Children and adolescents with acquired syphilis should have clinical and serologic response monitored at 3, 6, 9, 12, and 24 months after therapy.

Key to Acronyms: CDC = Centers for Disease Control and Prevention; IM = intramuscular; IV = intravenous; STD = sexually transmitted disease