Failure of Recommended Treatment for Secondary Syphilis

To the Editor.— Markovitz and associates1at the University of Rochester Department of Dermatology and Medicine again call to the attention of the practicing physician the inadequacy of the guidelines of the Centers for Disease Control (CDC) for the treatment of infectious syphilis in the primary and secondary stages and the early latent stage of less than one year's duration.2They had the unfortunate experience, as others have had,3of treating a patient with secondary syphilis with 2.4 million units of penicillin G benzathine intramuscularly in a single session, according to the CDC guidelines, only to have the patient relapse with secondary syphilis and a basilar meningitis three months after treatment. Dr Markovitz refers to our studies on the treatment of primary and secondary syphilis with 2.4 million units of penicillin G benzathine intramuscularly each week for two consecutive weeks, for a total of 4.8 million units.