Syphilis during pregnancy

All women in early pregnancy should be screened for syphilis. In populations where optimal prenatal monitoring is not possible, screening with the RPR test and treatment (with positive test results) is performed at the time of pregnancy. In communities and populations with a high incidence of syphilis or in high-risk patients, serological testing should be repeated in the third trimester of pregnancy and before childbirth. In all cases of stillbirth after 20 weeks of pregnancy, it is necessary to conduct a study on syphilis. No child can be discharged from the hospital without a documented confirmation of serological status at least once during pregnancy.

Diagnosis of syphilis in pregnancy

All seropositive pregnant women are considered to be infected if there is no documented confirmation of treatment performed in the medical facility and there was no corresponding decrease in antibody titers in serological tests.

[1], [2], [3], [4], [5], [6]

Treatment of syphilis in pregnancy

Penicillin is an effective drug to prevent the transmission of infection to the fetus or to treat a fetal infection. However, an insufficient amount of data has been obtained to determine whether the specific recommended regimens for penicillin are optimal.

Recommended regimens for the treatment of syphilis in pregnancy

Treatment during pregnancy should be done with penicillin according to the scheme corresponding to the syphilis stage found in a woman.

Other remarks on the management of pregnant women

Some experts recommend additional treatment under certain circumstances. A second dose of benzathine penicillin 2.4 million IU IM may be administered one week after the initial dose, for women with primary, secondary or early latent syphilis. Ultrasonic signs of syphilis of the fetus (ie, hepatomegaly and swelling) indicate ineffectiveness of treatment; in such cases, consultation with obstetricians should be carried out.

Women who received antisyphilitic treatment in the second half of pregnancy belong to the group of risk of premature birth or development of pathological conditions in the fetus, or both, if the treatment is accompanied by the response of Jarish-Hexheimer. These women should be advised to inform the doctor who is taking the medication of any changes in the fetal mobility or of uterine contractions. A rare complication of treatment is stillbirth; however, since treatment is necessary to prevent further damage to the fetus, this circumstance should not affect the delay in starting treatment. All patients with syphilis should be offered HIV testing and consider the possibility of having a drug dependence.

Follow-up

Coordinated prenatal care and follow-up can facilitate the detection and treatment of pregnant women with syphilis. Serological control should be repeated in the third trimester and by the time of delivery. Serologic test ticks can be checked monthly in women with a high risk of reinfection or in areas with high prevalence of syphilis. Clinical manifestations and the level of antibodies should correspond to the stage of the disease. Many women will give birth before it becomes possible to reliably estimate the effectiveness of treatment for the serological response.

[7], [8], [9], [10], [11], [12],

Special Remarks

Allergy to penicillin

There are no alternative penicillin regimens for the treatment of syphilis in pregnant women. Pregnant women with an allergy to penicillin should be treated with penicillin after desensitization. Possible setting of skin tests.

Tetracycline and doxycycline are usually not used during pregnancy. Erythromycin should not be prescribed, since it does not guarantee the cure of the infected fetus. Data on the use of azithromycin or ceftriaxone is not enough to recommend their use during pregnancy.

[13], [14]