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Failure of Recommended Treatment for Secondary Syphilis-Reply

Richard C. Reichman, MD; David M. Markovitz, MD
JAMA. 1986;256(11):1443-1444. doi:10.1001/jama.1986.03380110049016.
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In Reply.—  We appreciate the comments of Dr Fiumara regarding our recently published case report. The article describes a case of clinical relapse of secondary syphilis after treatment with the CDC's recommended regimen.1,2 It was not our intention to indicate that the CDC guidelines are "inadequate" but rather to demonstrate that failures do occur and to stress the importance of careful follow-up. In fact, we suggest that the present regimen should continue to be employed until appropriately controlled studies demonstrate superiority of an alternative approach.We are familiar with Dr Fiumara's extensive experience using a total of 4.8 million units of penicillin G benzathine intramuscularly to treat primary and secondary syphilis. We take issue, however, with his suggestion that a study comparing 2.4 and 4.8 million units of intramuscular penicillin G benzathine has already been performed. In the study to which he refers,3 a treatment arm employing 4.8


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