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BRIEF COMMUNICATION

Azithromycin Compared with Penicillin G Benzathine for Treatment of Incubating Syphilis

Edward W. Hook, III, MD; Joan Stephens, RN; and David M. Ennis, MD

21 September 1999 | Volume 131 Issue 6 | Pages 434-437

Background: Preventive therapy is an important element of syphilis control efforts. No currently recommended, single-dose alternatives to penicillin G benzathine are available for treatment of incubating syphilis.

Objective: To evaluate the use of a single 1.0-g dose of azithromycin for treatment of persons recently exposed to sexual partners with infectious syphilis.

Design: Single-center, open-label, randomized pilot study to compare azithromycin with penicillin G benzathine therapy. Participants were evaluated serologically for 3 months.

Setting: Sexually transmitted disease clinic in Birmingham, Alabama.

Participants: 96 participants who in the preceding 30 days had been exposed to partners with infectious syphilis through sexual intercourse.

Measurements: Syphilis prevention, as indicated by nonreactive serologic tests (rapid plasma reagin and fluorescent treponemal antibody-absorbed), throughout the 3- month follow-up.

Results: Among 96 participants enrolled, none of 40 evaluable persons in the azithromycin group and none of 23 evaluable persons in the penicillin group developed evidence of syphilis. Significantly more penicillin-treated participants (21 of 44 [48%]) than azithromycin-treated participants (12 of 52 [23%]) became nonevaluable during follow-up (P = 0.01).

Conclusion: A single 1.0-g dose of azithromycin seems to be efficacious for prevention of syphilis in persons exposed to infected sexual partners.

Author and Article Information

From the University of Alabama at Birmingham School of Medicine and Jefferson County Department of Health, Birmingham, Alabama.

Grant Support: In part by National Institutes of Allergy and Infectious Diseases grant U19-AI38514 and by donation of medications by Pfizer, Inc., and Ortho-McNeil Pharmaceuticals.

Acknowledgments: The authors thank the disease intervention specialists of the Jefferson County Department of Health for assistance in patient referral and follow-up; Charity M. Richey, MPH, for data management and statistical assistance; and Sharron Hagy for assistance in manuscript preparation.

Requests for Reprints: Edward W. Hook III, MD, Department of Medicine, Division of Infectious Diseases, The University of Alabama at Birmingham, 229 Tinsley Harrison Tower, 1900 University Boulevard, Birmingham, AL 35294-0006.

Current Author Addresses: Dr. Hook: Department of Medicine, Division of Infectious Diseases, The University of Alabama at Birmingham, 229 Tinsley Harrison Tower, 1900 University Boulevard, Birmingham, AL 35294-0006.

Ms. Stephens: Jefferson County Department of Health, 1400 Sixth Avenue, South Birmingham, AL 35233.

Dr. Ennis: Baptist Medical Center, 840 Montclair Road, Suite 317, Birmingham, AL 35213-1944.

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