Two-week course of minocycline therapy for early syphilis compared with benzathine penicillin G: a single-centre retrospective cohort study

Syphilis is a sexually transmitted infection caused by the spirochaete Treponema pallidum. The standard treatment for early syphilis is a single dose of intramuscular benzathine penicillin G (BPG), while doxycycline for 14 days is an alternative.1 2 However, during global antibiotic shortages, doxycycline may be unavailable,3 and no universally accepted alternative treatment exists for patients with syphilis with penicillin allergy. Although minocycline, another tetracycline agent with a similar antimicrobial spectrum, is widely used for syphilis treatment in Japan,4 its efficacy remains uncertain.

We conducted a retrospective cohort study comparing serological cure rates among patients with early syphilis treated with a 2-week course of minocycline 100 mg two times a day or a single dose of BPG. Eligible patients visited Private Care Clinic Tokyo between January 2021 and December 2024. Serological cure was defined as either seroreversion (reactive to non-reactive rapid plasma reagin (RPR))…

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