Syphilis In Pregnancy

Clinical description

Syphilis is a STI caused by spirochete Treponema pallidumthat can be transmitted from mother to fetus.

Clinical Manifestation of Syphilis

• Primary Syphilis: Single painless ulcer (chancre)
• Secondary Syphilis: Rash involving the palms and soles, fever, malaise, arthritis, condyloma lata,

glomerulonephritis

• Tertiary (late) Syphilis: neurosyphilis, granulomatous disease of skin and subcutaneous tissues (gummatous

disease) Potential Adverse Pregnancy Outcomes

• Miscarriage
• Preterm birth
• Still birth
• Congenital infection
• Perinatal Death

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

Treatment

• Benzathine penicillin G 2.4 MU IM once weekly for 3doses (for latent syphilis, only 1 dose for primary

syphilis)

• If allergic to penicillin, thenerythromycin 500 mg PO QID x 14 days for early syphilis or

erythromycin 500mg QID for 30 days

• After sexual contact with a known or possibly infected individual, presumptive treatment with single dose

of penicillin G benzathine 2.4 MU IM x 1.

• Monitor for Jarisch-Herxheimer reaction, an acute febrile reaction with headache, myalgia, rash and

hypotension.

• It may also cause preterm labor.
• Partner notification and treatment.
• Fetal US to identify severely infected fetus(placentomegaly, IUGR, microcephaly,

hepatosplenomegaly,hydrops, ascites, polyhydramnios).

• Alert paediatricians so that they can evaluate the neonate for congenital syphilis.