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