Syphilis in Pregnancy

Abstract

Importance Since 2013, the United States has seen a rise in cases of congenital syphilis, culminating in a relative increase of 153% from 2013 to 2017 and 918 reported cases in 2017. In all, 50% to 80% of pregnant women with syphilis experience an adverse pregnancy outcome including stillbirth or spontaneous abortion. Objective This article aims to review the current evidence and recommendations for management of syphilis in pregnancy. Evidence Acquisition Original research articles, review articles, and guidelines on syphilis were reviewed. Results In pregnancy, routine screening for syphilis is recommended on initiation of prenatal care. In high-risk populations, repeat testing is recommended in the early third trimester and at delivery. Penicillin remains the recommended treatment in pregnancy. After treatment, nontreponemal titers should be repeated at minimum during the early third trimester and at delivery to assess for serologic response. In high-risk populations, titers should be repeated monthly. Conclusion and Relevance Routine screening in pregnancy is essential for identification of syphilis infection and prevention of congenital syphilis. Subsequent adequate treatment with penicillin therapy more than 30 days before delivery and at the correct dosages depending on the stage of infection should be incorporated into clinical practice. Target Audience Obstetricians and gynecologists, family physicians Learning Objectives After completion of this educational activity, the obstetrician/gynecologist should be better able to summarize current knowledge of how syphilis impacts maternal and neonatal outcomes; describe the recommended screening and diagnostic tests for syphilis; and outline the treatment regimens and follow-up recommendations for management of syphilis in pregnancy.

Global Burden of Sexually Transmitted Infections: 1990 - 2019

“…[34] The screening in high-risk pregnant women is also an important measure. [35] We also found a paradoxical phenomenon that the < 14 years age group had the lowest age-standardized incidence rate but the highest age-standardized death and DALYs rate. This may because of the early and unprotected sex in adolescents [36,37] which may result in longer exposure to STIs.…”

Maternal syphilis treatment and pregnancy outcomes: a retrospective study in Jiangxi Province, China

“…Early diagnosis and early su cient penicillin treatment play a crucial role on syphilis management in pregnancy (15)(16)(17)(18). In order to prevent CS and other adverse pregnancy outcomes caused by maternal syphilis, WHO recommends that all syphilis infected pregnant women should receive at least one dose of benzathine penicillin G (BPG) in the rst trimester (19,20).…”

Maternal syphilis treatment and pregnancy outcomes: a retrospective study in Jiangxi Province, China

“…Early diagnosis and early su cient penicillin treatment play a crucial role on syphilis management in pregnancy (15)(16)(17)(18). In order to prevent CS and other adverse pregnancy outcomes caused by maternal syphilis, WHO recommends that all syphilis infected pregnant women should receive at least one dose of benzathine penicillin G (BPG) or an alternative effective regimen in the rst trimester (19).…”