Emerging treatments

Azithromycin

Azithromycin may be an option in special circumstances only when local susceptibility to azithromycin is likely.[4]  Data regarding resistance to azithromycin for treating syphilis in specific settings are not available, and will likely remain unknown. The World Health Organization Guideline Development Group notes concerns about the risk of azithromycin resistance in Treponema pallidum.[4] 

Ceftriaxone

Ceftriaxone has been used to treat late latent syphilis and neurosyphilis. Evidence C However, there is no clear consensus regarding the optimal duration of treatment. Results from meta-analyses have found ceftriaxone to be non-inferior to penicillin in terms of cure rates, relapse rates, and serofast rates.[106][107]  In patients with penicillin allergy, there is a low risk of allergic reaction with ceftriaxone due to cross-sensitivity, and it may be given in patients with no history of anaphylaxis.

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