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Parentral penicillin G is the preferred therapy for all phases of syphilis.

Syphilis is described in four stages

• Primary with a localized ulcer at site of inoculation (chancer)
• Secondary which can occur one or two months later with fever, malaise, lymphadenopathy and mucocutaneous changes including palm involvement and resolves without treatment. This phase can mimic many other conditions.
• Latent phase which can last years to decades
• Tertiary syphilis including gumma, cardiac involvement and neurosyphilis

Treatment is with parentral penicillin G.

References:

Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015 Jun 5;64(RR-03):1-137.PMID: 26042815

American Academy of Pediatrics. Syphilis. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. American Academy of Pediatrics; 2018;