Updated Recommendation
A new evidence synthesis was published:2024, Updated recommendations for the treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum (syphilis) and new recommendations on syphilis testing and partner services.
View latest version (2024)Bibliographic Info
Recommendation
Recommended in favor
Conditional
Certainty of evidence
Very low
In pregnant women with late syphilis (more than two years’ duration) or unknown stage of syphilis, the WHO STI guideline suggests benzathine penicillin G 2.4 million units intramuscularly once weekly for three consecutive weeks over procaine penicillin 1.2 million units intramuscularly once a day for 20 days. When benzathine or procaine penicillin cannot be used (e.g. due to penicillin allergy where penicillin desensitization is not possible) or are not available (e.g. due to stockouts), the WHO STI guideline suggests using, with caution, erythromycin 500 mg orally four times daily for 30 days.
Notes and Remarks
- 1.This is defined as: positive syphilis test without presence of any symptoms of more than two years’ duration (late latent syphilis) or of unknown duration of untreated infection
Also Featured In
This recommendation also appears in the following guidelines:
WHO recommendations on maternal health: guidelines approved by the WHO Guidelines Review Committee, second edition. Geneva: World Health Organization; 2025