Hunt Travis J, Berzkalns Anna, Cannon Chase A, Menza Tim W, Dombrowski Julia C, Golden Matthew R
HIV/STI/HCV Program, Public Health-Seattle & King County, Seattle, WA.
Sex Transm Dis. 2025 Aug 1;52(8):457-461. doi: 10.1097/OLQ.0000000000002148. Epub 2025 Mar 3.
The Centers for Disease Control and Prevention recommends treating latent syphilis of late/unknown duration (LSUD) with 3 doses of intramuscular benzathine penicillin G (BPG) or 28 days of oral doxycycline. This recommendation lacks high-quality evidence.
Using public health surveillance data from King County, Washington, we conducted a retrospective cohort study comparing rates of serological cure (≥2-titer reactive plasma reagin [RPR] decline) among persons with LSUD following receipt of 1 of 3 regimens: 1 dose of BPG, 3 doses of BPG, and 28 days of doxycycline. Subjects included persons diagnosed in 2007 to 2020 with an initial RPR ≥1:2 and follow-up RPR testing 1 to 36 months after treatment. We stratified initial RPRs into high and low titer (≥1:32, <1:32) and compared outcomes using Cox proportional hazards.
The study population included 761 persons with median time from treatment to last RPR/serological cure of 219 days (interquartile range, 114-488 days). Among high-titer persons, serological cure occurred in 36 of 41 (88%), 330 of 376 (88%), and 58 of 64 (88%) receiving single-dose BPG, 3-dose BPG, and doxycycline, respectively. Among low-titer persons, serological cure occurred in 4 of 13 (31%), 114 of 235 (49%), and 14 of 30 (47%) receiving single-dose BPG, 3-dose BPG, and doxycycline, respectively. Controlling for initial RPR, serological cure did not differ between high-titer persons receiving 1- and 3-dose BPG (adjusted hazard ratio, 0.89; 95% confidence interval, 0.63-1.26) or 1-dose BPG and 28 days of doxycycline (adjusted hazard ratio, 1.03; 95% confidence interval, 0.68-1.58).
Serological outcomes in high-titer LSUD after 1 dose of BPG, 3 doses of BPG, and 28 days of doxycycline are similar.
美国疾病控制与预防中心建议采用3剂肌肉注射苄星青霉素G（BPG）或28天口服强力霉素治疗病程晚期/不明的潜伏梅毒（LSUD）。这一建议缺乏高质量证据。
利用华盛顿州金县的公共卫生监测数据，我们开展了一项回顾性队列研究，比较接受以下3种方案之一的LSUD患者的血清学治愈（反应素环状卡片试验[RPR]滴度至少下降2倍）率：1剂BPG、3剂BPG和28天强力霉素。研究对象包括2007年至2020年诊断为初始RPR≥1:2且治疗后1至36个月进行RPR随访检测的患者。我们将初始RPR分为高滴度和低滴度（≥1:32、<1:32），并使用Cox比例风险模型比较结果。
研究人群包括761人，从治疗到最后一次RPR/血清学治愈的中位时间为219天（四分位间距，114 - 488天）。在高滴度患者中，接受单剂BPG、3剂BPG和强力霉素治疗的患者血清学治愈率分别为41例中的36例（88%）、376例中的330例（88%）和64例中的58例（88%）。在低滴度患者中，接受单剂BPG、3剂BPG和强力霉素治疗的患者血清学治愈率分别为13例中的4例（31%）、235例中的114例（49%）和30例中的14例（47%）。在控制初始RPR后，接受1剂和3剂BPG的高滴度患者之间（调整后风险比，0.89；95%置信区间，0.63 - 1.26）或接受1剂BPG和2周强力霉素的患者之间（调整后风险比，1.03；95%置信区间，0.68 - 1.58）血清学治愈情况无差异。
1剂BPG、3剂BPG和28天强力霉素治疗高滴度LSUD后的血清学结果相似。
