Syphilis management during pregnancy: Difference between revisions
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(Created page with "{{Syphilis}} {{CMG}}; {{AOEIC}} {{LG}} ==Overview== *All women should be screened serologically for syphilis early in pregnancy. *Mos...") |
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*No infant should leave the hospital without the maternal serologic status having been determined at least once during pregnancy. | *No infant should leave the hospital without the maternal serologic status having been determined at least once during pregnancy. | ||
==Diagnostic considerations== | |||
*Seropositive pregnant women should be considered infected unless an adequate treatment history is documented clearly in the medical records and sequential serologic antibody titers have declined. | |||
*Serofast low antibody titers might not require treatment; however, persistent higher titer antibody tests might indicate reinfection, and treatment might be required. | |||
==Treatment== | |||
[[Penicillin]] is effective for preventing maternal transmission to the fetus and for treating fetal infection.<ref name="pmid9916946">Alexander JM, Sheffield JS, Sanchez PJ, Mayfield J, Wendel GD (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9916946 Efficacy of treatment for syphilis in pregnancy.] ''Obstet Gynecol'' 93 (1):5-8. PMID: [http://pubmed.gov/9916946 9916946]</ref> Evidence is insufficient to determine optimal, recommended penicillin regimens.<ref name="pmid11686978">Walker GJ (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11686978 Antibiotics for syphilis diagnosed during pregnancy.] ''Cochrane Database Syst Rev'' (3):CD001143. [http://dx.doi.org/10.1002/14651858.CD001143 DOI:10.1002/14651858.CD001143] PMID: [http://pubmed.gov/11686978 11686978]</ref> | |||
==CDC Recommendations: Pharmacotherapy [http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5912a1.htm]== | |||
{{cquote| | |||
====Recommended Regimen==== | |||
'''1.''' Pregnant women should be treated with the penicillin regimen appropriate for their stage of infection.}} | |||
==References== | ==References== | ||
Revision as of 21:50, 17 February 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]
Overview
- All women should be screened serologically for syphilis early in pregnancy.
- Most states mandate screening at the first prenatal visit for all women;[1] antepartum screening by nontreponemal antibody testing is typical, but in some settings, treponemal antibody testing is being used.
- Pregnant women with reactive treponemal screening tests should have confirmatory testing with nontreponemal tests with titers.
- In populations in which use of prenatal care is not optimal, RPR test screening and treatment (if the RPR test is reactive) should be performed at the time that pregnancy is confirmed.
- For communities and populations in which the prevalence of syphilis is high and for patients at high risk, serologic testing should be performed twice during the third trimester (ideally at 28-32 weeks' gestation) and at delivery.
- Any woman who delivers a stillborn infant after 20 weeks' gestation should be tested for syphilis.
- No infant should leave the hospital without the maternal serologic status having been determined at least once during pregnancy.
Diagnostic considerations
- Seropositive pregnant women should be considered infected unless an adequate treatment history is documented clearly in the medical records and sequential serologic antibody titers have declined.
- Serofast low antibody titers might not require treatment; however, persistent higher titer antibody tests might indicate reinfection, and treatment might be required.
Treatment
Penicillin is effective for preventing maternal transmission to the fetus and for treating fetal infection.[2] Evidence is insufficient to determine optimal, recommended penicillin regimens.[3]
CDC Recommendations: Pharmacotherapy [3]
| “ |
Recommended Regimen1. Pregnant women should be treated with the penicillin regimen appropriate for their stage of infection. |
” |
References
- ↑ Hollier LM, Harstad TW, Sanchez PJ, Twickler DM, Wendel GD (2001) Fetal syphilis: clinical and laboratory characteristics. Obstet Gynecol 97 (6):947-53. PMID: 11384701
- ↑ Alexander JM, Sheffield JS, Sanchez PJ, Mayfield J, Wendel GD (1999) Efficacy of treatment for syphilis in pregnancy. Obstet Gynecol 93 (1):5-8. PMID: 9916946
- ↑ Walker GJ (2001) Antibiotics for syphilis diagnosed during pregnancy. Cochrane Database Syst Rev (3):CD001143. DOI:10.1002/14651858.CD001143 PMID: 11686978