Guidelines for the Management of Sexually Transmitted Infections. February 2004
(2004; 88 pages)
Table of Contents
View the documentPREFACE
Open this folder and view contents1. INTRODUCTION
Open this folder and view contents2. TREATMENT OF STI-ASSOCIATED SYNDROMES
Close this folder3. TREATMENT OF SPECIFIC INFECTIONS
Open this folder and view contents3.1. Gonococcal infections
Open this folder and view contents3.2. Chlamydia trachomatis infections (other than lymphogranuloma venereum)
View the document3.3. Lymphogranuloma venereum
Close this folder3.4. Syphilis
View the documentEarly syphilis
View the documentLate latent syphilis
View the documentNeurosyphilis
View the documentSyphilis and HIV infection
View the documentSyphilis in pregnancy
View the documentCongenital syphilis
View the document3.5. Chancroid
View the document3.6. Granuloma inguinale (Donovanosis)
Open this folder and view contents3.7. Genital herpes infections
Open this folder and view contents3.8. Venereal warts
View the document3.9. Trichomonas vaginalis infections
Open this folder and view contents3.10. Bacterial vaginosis
Open this folder and view contents3.11. Candidiasis
View the document3.12. Scabies
View the document3.13. Phthiriasis (pediculosis pubis)
Open this folder and view contents4. KEY CONSIDERATIONS UNDERLYING TREATMENTS
Open this folder and view contents5. PRACTICAL CONSIDERATIONS IN STI CASE MANAGEMENT
Open this folder and view contents6. CHILDREN6, ADOLESCENTS AND SEXUALLY TRANSMITTED INFECTIONS
View the documentANNEX. LIST OF PARTICIPANTS
 

Syphilis in pregnancy

Pregnant women should be regarded as a separate group requiring close surveillance, in particular to detect possible reinfection after treatment has been given. It is also important to treat the sexual partner(s).

Recommended regimens

Pregnant patients at all stages of pregnancy, who are not allergic to penicillin, should be treated with penicillin according to the dosage schedules recommended for the treatment of non-pregnant patients at a similar stage of the disease.

Alternative regimens for penicillin-allergic pregnant patients

a. Early syphilis

• erythromycin, 500mg orally, 4 times daily for 15 days

b. Late syphilis

• erythromycin, 500mg orally, 4 times daily for 30 days.

Note

The effectiveness of erythromycin in all stages of syphilis and its ability to prevent the stigmata of congenital syphilis are highly questionable, and many failures have been reported. Its efficacy in neurosyphilis is probably low. Although data are lacking, consideration should probably be given to using an extended course of a third-generation cephalosporin in pregnant women whose allergy is not manifested by anaphylaxis.

Penicillin desensitisation of pregnant women with syphilis requires that the procedure be performed in a hospital setting. This is not feasible at most primary health care settings and can not be recommended as a routine procedure.

Follow-up

Following treatment, quantitated non-treponemal serological tests should be performed at monthly intervals until delivery, and re-treatment should be undertaken if there is serological evidence of reinfection or relapse.

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