The widespread prevalence and spread of syphilis has become a serious public health problem in countries around the world, including China. In recent years, the incidence of syphilis has gradually increased and there are more and more patients with syphilis. How to treat syphilis correctly and in a standardized manner is receiving widespread attention. For syphilis treatment, many countries have developed and constantly updated their treatment norms. The treatment of syphilis must be timely and early; regular and adequate treatment. The efficacy of treatment depends on: the drug chosen, the dose, the course of treatment, the stage of syphilis, and the immunity of the organism. Early syphilis penicillin treatment is effective, RPR is generally negative within 6-12 months, but TPHA or TPPA is generally not negative, the literature reports that the treatment failure rate is 10%, early syphilis appears clinical relapse and serum resistance should be retreatment, such as RPR titer for a long time higher titer (such as 1:8, > 1 year) to give retreatment. It is best to do cerebrospinal fluid examination before retreatment to prevent occult neurosyphilis, late syphilis only penicillin is more effective. RPR is generally not negative, and clinical and serological follow-up should be done at 3, 6, 12, 18, 24 (or up to 36 months) after treatment, and a 4-fold or more decrease in RPR antibody titers indicates effective treatment. Ninety-seven percent of seropositive stage 1 syphilis and 76% of stage 2 syphilis patients are seronegative within 2 years of treatment. If the initial titer is very high, even a 4-fold decrease does not indicate a cure. If the non-spirochete titer rises 4-fold after treatment without reinfection, a lumbar puncture is indicated. If the non-spirochete titer is initially low or absent and increases after treatment, this indicates treatment failure and requires further testing. In a small number of patients, after anti-syphilis treatment, the titer of non-syphilis spirochete antibody drops to a certain level and then stops dropping and remains at a low titer for a long time, which is the phenomenon of serum fixation. Treatment: If the drug dose is insufficient or the treatment is irregular, a course of treatment should be made up. Perform a comprehensive physical examination, including neurological and cerebrospinal fluid examination, for early detection of asymptomatic neurosyphilis and cardiovascular syphilis. Perform HIV testing if necessary. Strictly regular observation, including general physical examination and serum follow-up. If the titer tends to rise, treatment should be repeated. In untreated early syphilis, 25% had severe damage occurring, compared to 35% to 40% in those who received inappropriate treatment, with worse outcomes than those who were untreated. This suggests that irregular treatment can increase recurrence and contribute to the early onset of late damage. Adequate post-treatment follow-up. Penicillin is the drug of choice for the treatment of all stages of syphilis, and the appropriate penicillin dosage form needs to be selected for the treatment of each stage of syphilis. The life cycle of syphilis spirochetes is 30-33 hours, and only the reproductive spirochetes are sensitive to penicillin, so long-acting penicillin is required. The life cycle of spirochetes in advanced syphilis is longer. The plasma concentration of penicillin for syphilis requires >0.03 U/mL for more than 2 weeks. Excessive dose increases are not necessary, but a certain course of treatment is required. Treatment failure in pregnant women, immunocompetent individuals, and those with co-infection with HIV is more commonly seen with the application of benzathine penicillin than with procaine penicillin. Tetracyclines and erythromycin are less effective than penicillin for syphilis and are only indicated for those allergic to penicillin. A study in the United States: early syphilis Doxycycline is effective in the treatment of early syphilis. More clinical trials are necessary to determine the best treatment option. Jihai reactions occur mostly after penicillin treatment for early syphilis. Presentation: It occurs 4 hours after administration, peaks at 8 hours, and ends at 24 hours. The prodromal symptoms include general malaise, increased body temperature, headache, chills, peripheral vasoconstriction with increased blood pressure, tachycardia, nausea, vomiting, muscle and joint pain, followed by peripheral vasodilation and decreased blood pressure, and exacerbation of existing syphilis damage. The incidence of late syphilis is lower, but more dangerous, and fetal syphilis mostly occurs in children born within 6 months of syphilis. The Gihay reaction can lead to preterm delivery and fetal distress in pregnant women, but this should not be left untreated or delayed.