One dose of penicillin can treat early syphilis

A randomized clinical trial has found that a single dose of benzathine penicillin G is just as effective as the traditional three-dose regimen for treating early syphilis, potentially reshaping long-standing treatment practices.

The study, published in the New England Journal of Medicine, enrolled 249 adults with early syphilis and randomly assigned them to receive either one dose or three weekly doses of penicillin. After six months, 76% of participants in the one-dose group showed a successful serologic response, compared to 70% in the three-dose group, meeting the criteria for noninferiority.

Effectiveness did not differ by HIV status, according to the study. Among participants with HIV, the response rate was 76% for one dose and 71% for three. No treatment failures or clinical relapses were reported in either group.

“In this trial, the most common adverse event reported by participants was injection-site pain and tenderness,” the authors wrote, noting that discomfort and repeated visits may discourage patients from completing multi-dose treatments.

The study also comes amid recurring shortages of benzathine penicillin G in the U.S., highlighting the potential benefits of a simplified treatment approach for both patients and public health systems. Researchers concluded that “a single treatment at a dose of 2.4 million units should be, in our opinion, the preferred treatment for early syphilis.”

Read more: New England Journal of Medicine

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