{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T20:48:44Z","timestamp":1791838124382,"version":"4.3.4"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T00:00:00Z","timestamp":1710288000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Penicillin's long-standing role as the reference standard in syphilis treatment has led to global reliance. However, this dependence presents challenges, prompting the need for alternative strategies. We performed a systematic literature review and meta-analysis to evaluate the efficacy of these alternative treatments against nonneurological syphilis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, Embase, Cochrane, Scopus, and Web of Science from database inception to 28 August 2023, and we included studies that compared penicillin or amoxicillin monotherapy to other treatments for the management of nonneurological syphilis. Our primary outcome was serological cure rates. Random-effect models were used to obtain pooled mean differences, and heterogeneity was assessed using the I2 test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 6478 screened studies, 27 met the inclusion criteria, summing 6710 patients. The studies were considerably homogeneous, and stratified analyses considering each alternative treatment separately revealed that penicillin monotherapy did not outperform ceftriaxone (pooled odds ratio, 1.66 [95% confidence interval, .97\u20132.84]; I2 = 0%), azithromycin (0.92; [.73\u20131.18]; I2 = 0%), or doxycycline (0.82 [.61\u20131.10]; I2 = 1%) monotherapies with respect to serological conversion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Alternative treatment strategies have serological cure rates equivalent to penicillin, potentially reducing global dependence on this antibiotic.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofae142","type":"journal-article","created":{"date-parts":[[2024,3,11]],"date-time":"2024-03-11T19:24:18Z","timestamp":1710185058000},"source":"Crossref","is-referenced-by-count":19,"title":["Syphilis Treatment: Systematic Review and Meta-Analysis Investigating Nonpenicillin Therapeutic Strategies"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6694-6569","authenticated-orcid":false,"given":"Gustavo Yano","family":"Callado","sequence":"first","affiliation":[{"name":"Faculdade Israelita de Ci\u00eancias da Sa\u00fade Albert Einstein, Hospital Israelita Albert Einstein , S\u00e3o Paulo, S\u00e3o Paulo , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Celidonio","family":"Gutfreund","sequence":"additional","affiliation":[{"name":"Faculdade Israelita de Ci\u00eancias da Sa\u00fade Albert Einstein, Hospital Israelita Albert Einstein , S\u00e3o Paulo, S\u00e3o Paulo , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabele","family":"Pardo","sequence":"additional","affiliation":[{"name":"Faculdade Israelita de Ci\u00eancias da Sa\u00fade Albert Einstein, Hospital Israelita Albert Einstein , S\u00e3o Paulo, S\u00e3o Paulo , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana Kim","family":"Hsieh","sequence":"additional","affiliation":[{"name":"Faculdade Israelita de Ci\u00eancias da Sa\u00fade Albert Einstein, Hospital Israelita Albert Einstein , S\u00e3o Paulo, S\u00e3o Paulo , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivian","family":"Lin","sequence":"additional","affiliation":[{"name":"Faculdade Israelita de Ci\u00eancias da Sa\u00fade Albert Einstein, Hospital Israelita Albert Einstein , S\u00e3o Paulo, S\u00e3o Paulo , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mindy Marie","family":"Sampson","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases & Geographic Medicine, Stanford University , Stanford, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillermo Rodriguez","family":"Nava","sequence":"additional","affiliation":[{"name":"Division 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