Syphilis in Pregnancy

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

Clinical Features

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.

Treatment

PHARMACOLOGICAL

  • Benzathine penicillin 2.4MU IM once weekly for 3 doses (for latent syphilis, only 1 dose 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 30 days
  • 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).