Review of Current Evidence and Comparison of Guidelines for ...

EUR/03/5045931
page 34
The period 1981–1988 was revolutionary because arsenic and bismuth preparations were
cancelled. So the era of syphilis treatment by extremely harmful preparations had ended. Some
other preparations were introduced, such as erythromycin, tetracycline, etc. This allowed for
syphilis treatment policy more flexible.
In 1995 modern foreign manufactured lasting preparations, such as benzatinbenzylpenicillins,
were introduced in the treatment schemes. Today 80% of the patients receive outpatient
treatment. The outpatient treatment has given an opportunity to manage a large quantity of
diseased patients while the STI epidemic.
Table 1. Basic changes in syphilis treatment policy in the former Soviet Union (and Russia) in 1932–2002
Years The basic changes of the contents of Methodical instructions
1932
1945
1948
1951
1954
1962
1976
1981
1988
1993
1995
1999
Medical preparations of heavy metals (bismuth, mercury), arsenic, iodine
–
Introduction in circuits of treatment of soluble penicillin
–
–
Introduction in circuits of treatment by domestic lasting preparations of penicillin:
ecmonovocillin, bicillin-1, bicillin-3.Cancellation of mercury preparations
Introduction of permanent methods of treatment with lasting preparations of
penicillin for the separate categories, the limited introduction of outpatient treatment
Arsenic preparations cancellation
Bismuth preparations cancellation; course treatment cancellation. Introduction of
out-patient treatment of syphilis. Introduction of alternative preparations
(erythromycin, doxicycline)
–
The circular introduction in the circuits of treatment with foreign and domestic
benzatin penicillins. The beginning of transition into total outpatient treatment
Increase in single dozes of soluble penicillin up to one million units, reduction of
duration of treatment of patients with primary and secondary syphilis by soluble
penicillin. Introduction of procaine penicillin as one of the basic antibiotics and
ceftriaxone, as an alternative preparations
By the present time in order to develop new guidelines on syphilis treatment the data of the
modern foreign literature and separate scientists’ opinions without generalized analytical
processing have been used. As a rule when using foreign manufactured methods the preparation
doses were increased.
For example: two injections of benzatinpenicillin, 2.4 million units for primary syphilis
treatment, and three injections for secondary syphilis treatment (instead of one injection
according to the CDC recommendation); or introduction of procaine penicillin in a dose
1 200 000 units per a day within 20 days (instead of 10 days on CDC), etc.
Basic contests of the Methodological Guidelines on syphilis treatment and prevention,
Moscow, 1999 (2)
According to this document there are the following schemes of syphilis treatment: