- Keywords > Clinical Practice Guidelines (CPGs)
- Keywords > criteria of medicines selection
- Keywords > HIV infection and STIs
- Keywords > opportunistic infections and other HIV-related
- Keywords > reproductive tract infections
- Keywords > sexual and reproductive health
- Keywords > sexually transmitted infections (STIs)
- Keywords > treatment guidelines
- Keywords > treatment protocols
(2004; 88 pages)
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).
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.
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.
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.