Patient Population: Pediatric

This and other STI sections are not meant to be comprehensive references for all STI treatment but primarily focused on the most commonly used initial empiric antimicrobial therapy. Users should refer to linked resources (SFDPH City Clinic protocols, CDC guidelines) or other local resources to provide patients and their partners appropriate counseling and follow-up. For non-adolescent age patients, patients with STIs not addressed in these guidelines, or patients with contraindications to the listed therapies, we recommend referring to the linked resources, or Lexi-Comp for medication information, or consulting ID/ASP for individualized recommendations. 

Condition Major Pathogens  First Choice Therapy Alternative Therapy Comments

Syphilis, adolescent treatment 

See separate Congenital Syphilis section

Treponema pallidum

Primary, secondary, or early latent:  

Benzathine Penicillin G 50,000 units/kg (max 2.4 million units/dose) IM x 1 dose 


Late latent, or latent of unknown duration

Benzathine Penicillin G 50,000 units/kg/dose (max 2.4 million units/dose) IM qweek x 3 doses 

Penicillin allergy with higher risk for allergic reaction, patient not pregnant

100mg/dose enterally bid x 14 days 

Consult ID/ASP for other options if doxycycline contraindicated 

Sexual partners should be notified and evaluated per linked SFDPH City Clinic guidelines below, following recommendations based on the patient’s stage of infection 

RPR titer should be checked on the day of treatment to provide baseline for follow-up serology monitoring 

Refer to SFDPH City Clinic STI protocols section on syphilis for recommended laboratory evaluation (including testing for other STIs), and further recommendations on partner treatment, counseling (including abstinence from sex during patient and partner treatment), and follow up (including retesting recommendations based on stage of infection) 

Patients who are receiving three doses of penicillin must restart their treatment if more than 10 days elapse since the last dose. They should also receive each dose no sooner than five days since the preceding one. 


Workowski KA, et al. Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep 2021;70:1-187.

Pediatric Empiric Antimicrobial Therapy Guidelines

This is a subsection of the UCSF Benioff Children’s Hospitals Empiric Antimicrobial Therapy Guidelines, developed by the Pediatric Antimicrobial Stewardship Programs at each campus to inform initial selection of empiric antimicrobial therapy for children at the UCSF Benioff Children’s Hospitals and affiliated outpatient sites. 

These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. Durations provided are usual recommendations for patients who are responding appropriately to therapy. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP) at the campus where your patient is receiving care.  

For questions or feedback about these guidelines, please email primary content owners, Rachel Wattier, Pediatric ASP Medical Director at BCH SF and Prachi Singh, Pediatric ASP Medical Director at BCH OAK. 

The content of these guidelines was updated in July 2021. See Summary and Rationale for Changes (password login to Box needed) for detailed explanations of the content changes.