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.

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. Evidence is insufficient to determine optimal, recommended penicillin regimens.

CDC Recommendations: Pharmacotherapy [3]

“

Recommended Regimen 1. Pregnant women should be treated with the penicillin regimen appropriate for their stage of infection.

”

References

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