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Alternative therapies (e.g., doxycycline, ceftriaxone, or azithromycin) haven't been evaluated amongst HIV-contaminated patients and shouldn't be used as first-line therapy (EIII) (154). Neurosyphilis must be treated with aqueous penicillin G 200,000--300,000 models/kg intravenously every 4--6 hours (maximum dosage: 18--24 million items/day) for 10--14 days (AII). An alternate to aqueous penicillin G is procaine penicillin G at 50,000 units/kg/dose intramuscularly (IM) daily in a single dose for 10 days (BII). Asymptomatic infants born to mothers who've had adequate therapy and response to therapy, and with a normal physical examination and CSF findings, and who have a serum quantitative nontreponemal serologic titer that is less than fourfold higher than maternal titer could be handled with a single dose of benzathine penicillin G 50,000 units/kg/dose IM with careful clinical and serologic follow-up (BII). Acquired syphilis in children is handled with a single dose of benzathine penicillin G 50,000 units/kg IM (as much as the adult dose of 2.Four million items) for early-stage disease (e.g., major, secondary, and early latent disease) (AII).