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The therapeutic agent of choice for all types of syphilis is penicillin, unless a patient is sensitive to penicillin, in which case other antibiotics may be used. The Treponema pallidum is extraordinarily sensitive to penicillin. No proved penicillin-resistant strains of the organism have been found. As a rule, relatively low blood concentrations of penicillin, sustained for 7 to 10 days in early and latent syphilis and for 10 to 20 days in late symptomatic cases, are sufficient to cure or permanently arrest the infection. Rarely, a patient may require more intensive treatment with preparations that provide higher blood concentrations of penicillin sustained over a longer period than is needed for the great majority of patients. Reasons for this are obscure, but it is possible that in rare cases penicillin is absorbed poorly from muscle depots. Whether or not this is true, increasing the total dosage of penicillin for the treatment
Thomas EW. CURRENT STATUS OF THERAPY IN SYPHILIS. JAMA. 1956;162(17):1536–1539. doi:10.1001/jama.1956.72970340003009
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