Table 2.

United States Centers for Disease Control and Prevention Recommendations for the Treatment of Ocular Syphilis

Test for HIV* (frequent co-infection)

Lumbar puncture even in the absence of clinical neurologic findings (neuro-syphilis frequently present) for CSF examination†

• If CSF examination abnormal, follow CSF with serial lumbar punctures as for neuro-syphilis to assess treatment response

Treat as neuro-syphilis regardless of lumbar puncture results

• 3–4 million units aqueous crystalline penicillin G intravenously every 4 hours for 10–14 days (or 18 to 24 million units per day continuous infusion)

• Consider adding following after completion of initial 10–14 days of treatment: benzathine penicillin, 2.4 million units once per week for up to 3 weeks

If non-treponemal serologic test abnormal pre-treatment, follow titer at 6, 12, and 24 months to assess response to therapy

• Titers ≥1:32 should have a 4-fold decline in titer by 12–24 months

^*HIV = human immunodeficiency virus.

^†CSF = cerebrospinal fluid.

Adapted from reference 2.