Syphilis in pregnancy

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