Treatment for Syphilis in Pregnancy

Treponema pallidum, the cause of syphilis, is highly transmissible, even in the absence of any specific symptoms or clinical findings. Maternal syphilis has been associated with complications such as hydramnios, spontaneous abortion, and preterm delivery. Fetal complications such as fetal syphilis, fetal hydrops, prematurity, fetal distress, and stillbirth also occur. Neonatal complications can include congenital syphilis, neonatal death, and late sequelae.

Screening is performed with a blood test-the rapid plasma reagin or Venereal Disease Research Laboratories test-and confirmed with a fluorescent treponemal antibody serology and T. pallidum particle agglutination. A single serologic test is insufficient because false-positives occur with other illnesses.

If syphilis is diagnosed after 20 weeks' gestation, ultrasonography should be performed to evaluate for fetal syphilis. Although fetal infection can be cured by treating the mother, treatment failure is much higher in the presence of fetal hepatomegaly, ascites, hydrops, polyhydramnios, and placental thickening, which are signs of fetal syphilis detected on ultrasonography.

Treatment has been with benzathine penicillin G. A Cochrane review concluded that although penicillin is effective for the treatment of syphilis in pregnancy and the prevention of congenital syphilis, the optimal treatment regimen is uncertain. The CDC recommends benzathine penicillin G, 2.4 million units intramuscularly, with desensitization in patients who are allergic to penicillin.

BARBARA A. MAJERONI, MD, and SREELATHA UKKADAM, MBBS
State University of New York at Buffalo, Buffalo, New York

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