Syphilis management during pregnancy

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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; 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.

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