Syphilis management in St. Petersburg, Russia: 1995-2001.

Objectives: The objectives of this study were to describe the recent syphilis epidemic in St. Petersburg Russia; and to document the syphilis management practices in Russia to help inform the best way forward for a system in transition. Design: This study was a retrospective cohort study of syphilis diagnosed and followed in St. Petersburg 1995-2001. Results: A total of 1024 persons were identified with syphilis. Persons treated for secondary syphilis with 400000 IU aqueous penicillin intramuscularly every 3 hours for 28 days or 2.4 µ benzathine penicillin intramuscularly weekly for 2 weeks responded most rapidly. Persons treated with 1.5 µ bicillin-5 intramuscularly at diagnosis and then two time per week for 3 weeks or 2.4 µ bicillin-1 intramuscularly weekly for 3 weeks displayed sluggish responses (P <0.0001). Regimens for treating later stages revealed similar responses (P = 0.21). Benzathine penicillin at a dosage of 2.4 µ intramuscularly weekly for 3 weeks was not a used regimen. Conclusion: Benzathine penicillin at a dosage of 2.4 µ intramuscularly weekly for 1 to 2 weeks is in moderate use but its use should increase; 2.4 µ benzathine penicillin intramuscularly weekly for 3 weeks should be introduced as the standard of care for late syphilis. The efficacy of the locally manufactured bicillin-1 and bicillin-5 is in question. (authors)