JAMA Netw Open

Oral doxycycline shows promise for ocular syphilis treatment

December 12, 2024

Study design: This retrospective cohort study compared the outcomes of outpatient oral doxycycline therapy with IV penicillin therapy in patients diagnosed with ocular syphilis in Los Angeles from January 1, 2017, to December 1, 2023. Starting in January 2022, oral doxycycline was offered through shared decision-making.

Results: Among 32 patients, 16 received oral doxycycline and 16 received IV penicillin. There were no significant differences in demographics or clinical characteristics between the groups. Median visual acuity at presentation and at final follow up was better in the doxycycline group than the penicillin group. Visual acuity improved or remained stable in 94% of patients, with no difference in ocular inflammation resolution rates. A 4-fold decrease in rapid plasma regain (RPR) titers was observed in all patients with at least 9 months of follow-up.

Impact on clinical practice: Oral doxycycline may be a viable alternative to IV penicillin for treating ocular syphilis, offering benefits such as avoiding hospitalization and indwelling IV lines. Further prospective studies are needed to confirm these findings and establish long-term efficacy and safety.

Source:

Bao YK, et al. (2024, December 2). JAMA Netw Open. Outpatient Oral Doxycycline Therapy for Ocular Syphilis. https://pubmed.ncbi.nlm.nih.gov/39641931/