Syphilis in Pregnancy

Clinical Description

Syphilis is an STI caused by Treponema pallidum that can be transmitted from mother to fetus.

Signs and Symptoms

• Primary Syphilis: Single painless ulcer (chancre)
• Secondary Syphilis: Rash involving the palms and soles, fever, malaise, arthritis, condylomalata, glomerulonephritis
• Tertiary (late) Syphilis: neurosyphilis, granulomatous disease of skin and subcutaneous tissues (gummatous disease)

Potential Adverse Pregnancy Outcomes: Miscarriage, Preterm birth, Fetal hydrops, Stillbirth, Congenital infection and Perinatal Death

Investigations

• All pregnant women should be screened for syphilis at their first contact with medical personnel using VDRL or RPR.

Pharmacological

• Benzathine penicillin 2.4MU IM once weekly for 3doses (for latent syphilis, only1dose for primary syphilis)
• If allergic to penicillin, then Erythromycin 500mg PO 6 hourly for 14 days for early syphilis or Erythromycin 500mg 6 hourly for 30days
• After sexual contact with a known or possibly infected individual, presumptive treatment with single dose of Benzathine Penicillin 2.4MU IM x1.
• Monitor for Jarisch-Herxheimer reaction, an acute febrile reaction with headache, myalgia, rash and hypotension.
• It may also cause preterm labour.
• Partner notification and treatment.
• Fetal USS to identify severely infected fetus (placentomegaly, IUGR, microcephaly, hepatosplenomegaly, hydrops, ascites, polyhydramnios).