Syphilis in pregnancy

From IDWiki

Background

  • Risk of transmission to fetus
    • Primary and secondary syphilis: 70 to 100%
    • Early latent syphilis: 40%
    • Late latent syphilis: 10%

Management

  • Antimicrobials
    • For primary, secondary, or early latent syphilis: benzathine penicillin G 2.4 million units IM weekly for 1-2 doses
    • For late latent, latent syphilis with unknown duration, or tertiary syphilis not involving the CNS: benzathine penicillin G 2.4 million units IM weekly for 3 doses
    • For tertiary neurosyphilis, treat as usual
  • Monitor response to treatment with RPR serology
    • Primary, secondary, and early latent
      • 1, 3, 6, and 12 months after treatment; or monthly until delivery, if high risk for reinfection
      • Primary should decrease 4-fold at 6 months and 8-fold at 12 months
      • Secondary should decrease 8-fold at 6 months and 16-fold at 12 months
      • Early latent should decrease 4-fold at 12 months
    • Late latent: at delivery, 12 months, and 24 months
    • Neurosyphilis: repeat lumbar puncture every 6 months until parameters normalize
      • CSF-VDRL titre should decrease 4-fold within a year but may take years to revert to negative
  • Postpartum, follow guidelines for congenital syphilis to decide whether and how to treat the neonate