Syphilis in Pregnancy

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All pregnant women should have a nontreponemal serologic test for syphilis at the time of the first prenatal visit. In women suspected of being at increased risk for syphilis or for populations in which there is a high prevalence of syphilis, additional nontreponemal tests should be performed during the third trimester at 28 weeks and again at delivery. The serologic status of all women who have delivered should be known before discharge from the hospital. Seropositive women should be considered infected and should be treated unless prior treatment with fall in antibody titer is medically documented.

The preferred treatment is with penicillin in dosage schedules appropriate for the stage of syphilis (see above). Penicillin prevents congenital syphilis in 90% of cases, even when treatment is given late in pregnancy. Tetracycline and doxycycline are contraindicated in pregnancy. Erythromycin should not be used because of failure to eradicate infection in the fetus, and insufficient data are available to justify a recommendation for ceftriaxone or azithromycin. Thus, women with a history of penicillin allergy should be skin tested and desensitized if necessary.

The infant should be evaluated immediately, as noted below, and at 6-8 weeks of age.

RELATED STORIES:
Late Latent ("Hidden") Syphilis   Syphilis Natural History & Principles of Diagnosis & Treatment   Syphilis in Human Immunodeficiency Virus-Infected Patients   Syphilis- Complications of Specific Therapy   Primary Syphilis   Secondary Syphilis   Syphilis - Laboratory Diagnosis   Late (Tertiary) Syphilis   Syphilis Prevention   Relapsing Syphilis (Early Latent Syphilis)   Syphilis Treatment   Congenital Syphilis

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