Herxheimer Reactions in Penicillin Treatment of Syphilis in Pregnancy

Bowen, Jack H.; Cole, H. N.; Driver, J. R.; Light, Richard C.; Rauschkolb, John E.; Gustafson, M. H.; Held, Burt; Kam, J. M.; Utterback, Manly; Walker, Allen E.

doi:10.1001/archderm.1948.01520250079008

Cited by 9 publications

(3 citation statements)

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“…72,75,[77][78][79] For these reasons, we recommend that all viable pregnancies, regardless of maternal stage, receive the first dose of BPG on a labor and delivery unit under continuous fetal monitoring with observation for at least 24 hours or until symptoms resolve. 72,77,80,81 However, lack of access to fetal monitoring should not delay timely maternal treatment. A discussion regarding symptoms of preterm labor or decreased fetal movement is encouraged in all women at the time of administration the first dose, especially if continuous fetal monitoring is not available.…”

Section: Jh Reactionmentioning

confidence: 99%

“…The median time of onset for uterine contractions and fetal heart rate abnormalities was 8 to 10 hours 72,75 . Preterm labor and stillbirth have also been reported 72,75,77‐79 . For these reasons, we recommend that all viable pregnancies, regardless of maternal stage, receive the first dose of BPG on a labor and delivery unit under continuous fetal monitoring with observation for at least 24 hours or until symptoms resolve 72,77,80,81 .…”

Section: Treatment During Pregnancymentioning

confidence: 99%

“…Preterm labor and stillbirth have also been reported 72,75,77‐79 . For these reasons, we recommend that all viable pregnancies, regardless of maternal stage, receive the first dose of BPG on a labor and delivery unit under continuous fetal monitoring with observation for at least 24 hours or until symptoms resolve 72,77,80,81 . However, lack of access to fetal monitoring should not delay timely maternal treatment.…”

Section: Treatment During Pregnancymentioning

confidence: 99%

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Congenital syphilis: A contemporary update on an ancient disease

2020

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Congenital syphilis (CS) rates reached a 20-year high in the United States in 2018. Unlike previous years, most babies diagnosed with CS were born to mothers who received prenatal care, indicative of the need for better provider education and guideline adherence. Current rates suggest that screening for syphilis should be performed at the first prenatal care visit and twice during the third trimester. There are two diagnostic algorithms available for use in the United States (traditional and reverse) and providers must understand how to perform each algorithm. Treatment should be administered according to stage of syphilis per Centers for Disease Control recommendations with best neonatal outcomes seen when treatment is initiated >30 days before delivery. Benzathine Penicillin G remains the only recommended treatment of syphilis during pregnancy. In viable pregnancies, a pretreatment ultrasound is recommended to identify sonographic evidence of fetal infection and treatment should be initiated with continuous fetal monitoring to evaluate for the Jarisch-Herxheimer reaction which can cause preterm labor and fetal distress. After adequate syphilotherapy, a fourfold decline in maternal nontreponemal titers may not be observed by delivery and does not correlate with rates of CS.

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