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

Foreword
EUR/03/5045931
page i
“Come now, what regimen, what cure must be adopted to combat this great plague and what is
appropriate at which stage of the illness I shall disclose and I shall expound the wonderful
discoveries of men.”
Girolamo Frascastoro’s Syphilis 1530 (1)
This technical document reviews and compares syphilis treatment guidelines from Europe, the
United Kingdom, the United States and Russian Federation. The guidelines and recommended
treatment regimens differ somewhat from one guideline to another even though they are largely
drawn from the same evidence.
The Russian Federation guidelines, however, differ considerably from the other three guidelines
in that they are based more on Russian experience and locally manufactured penicillin
formulations; where they recommend imported drugs, the recommended doses or duration of
therapy tend to exceed those in the other guidelines. The difference between guidelines from
Russian Federation and those from elsewhere is explained, in part, by the “historical aspect” of
syphilis management in this region.
Syphilis management in Russian Federation has been of special “interest” to many physicians,
almost mythical to others. Changes in policies for syphilis management are still ongoing in the
Commonwealth of Independent States (e.g. inpatient versus outpatient management;
dermatovenereologists versus primary health care concepts; locally manufactured drugs versus
imported ones; cost and quality aspects, etc.). Future guidelines will undoubtedly show further
evolution of thinking surrounding these and other issues.
Treatment of syphilis has always been complex and confusing, having come with different
recommendations in different guidelines for many years. There are areas of treatment where
more data are needed. These areas need to be clearly identified so that appropriate research
priorities can be defined and feasibility of such research established.
There is an obvious need to harmonize syphilis treatment guidelines not only in Europe but
globally, and this review contributes to the beginning of such a process.
Francis Jim Ndowa (WHO HQ FCH/RHR/RTI)