SYPHILIS
------------------------------------------------



I have diagnosed a case of secondary syphilis in a patient who is 
allergic to penicillin and tetracycline, 
with an apparent intolerance to erythromycin.  Has anyone had 
experience in using other drugs such as fluorquinolones.  Would use 
of a cephalosporin be too risky with the hx of penicillin allergy?

Any suggestions would be most appreciated.

Harold L. Blumenthal, M.D.
--------------------------



How about the new macrolides like clarithromycin or azithromycin?
They have less GI intolerance than erythro.

Fred Parker MD
---------------


With regard to the penicillin-
allergic case of secondary syphilis
(assuming biologic false positives
and other sources of error are 
eliminated):

Since the antigenic sites for reactivity to
cephalosporins are reportedly totally
different from those for penicillins,
there has been an increasing sense
of security in the use of cephalosporins
in penicillin-allergic individuals.
I would use cephalexin 500 mg qid in this
individual for 30 days. Following a 
quantitative RPR titer downward over
the subsequent year should add to your
security notwithstanding that some
patients' titers move down very slowly.

Norman Guzick, M.D.
-------------------