Syphilis In Pregnancy/prevention/treatment

 

Syphilis in pregnancy; is a sexually transmitted infection caused by treponema pallidum bacteria. It can seriously complicate pregnancy and result in spontaneous abortion, stillbirth, non-immune hydrops, intrauterine growth restriction, and perinatal death, as well as serious sequelae in liveborn infected children. In order to avoid that the following measures should be considered.

Silhouette of Pregnant Standing on Seashore during Golden Hour
Silhouette of Pregnant Standing on Seashore during Golden Hour

How to prevent syphilis in pregnacy

  1. All women should be screened serologically for syphilis early in pregnancy.
  2. In populations where prenatal care is not optimal, RPR test screening and treatment (if the RPR test is reactive) should be performed at the time pregnancy is confirmed .
  3. Nontreponemal quantitive test is used for monitoring pregnant women who have reactive traponemal screening test.
  4. Where prevalence of syphilis is high and for women at high risk for infection, serologic testing should also be performed twice during the third trimester: once at 28–32 weeks’ gestation and again at delivery.
  5. Any woman who has a fetal death after 20 weeks’ gestation should be tested for syphilis.
  6. No mother or neonate should leave the hospital without maternal serologic status having been documented at least once during pregnancy.

Diagnostic Considerations

  1. Seropositive pregnant women should be considered infected unless an adequate treatment history is documented clearly in the medical records and sequential serologic antibody titers have declined appropriately for the stage of syphilis.
  2. Quantitative maternal nontreponemal titer, especially if >1:8, might be a marker of early infection and bacteremia.
  3. The risk for fetal infection is still significant in pregnant women with late latent syphilis and low titers.
  4. Pregnant women with stable, serofast low antibody titers who have previously been treated for syphilis might not require additional treatment
  5. Those with rising or persistently high antibody titers might indicate reinfection or treatment failure, and treatment should be considered.
  6. For women with a history of adequately treated syphilis who do not have ongoing risk, no further treatment is necessary.
  7. Women without a history of treatment should be staged and treated accordingly with a recommended penicillin regimen.

Treatment

Penicillin G is the only known effective antimicrobial for preventing maternal transmission to the fetus and treating fetal infection . Evidence is insufficient to determine optimal, recommended penicillin regimens.

Recommended Regimen

  • Pregnant women should be treated with the penicillin regimen appropriate for their stage of infection.

Other Management Considerations

  • Studies suggests that additional therapy is beneficial for you while pregnant. In case you have primary, secondary, or early latent syphilis, a second dose of benzathine penicillin 2.4 million units IM can be administered 1 week after the initial dose .
  • In case you are diagnosed with syphilis  second trimester, management should include a sonographic fetal evaluation for congenital syphilis. However, this evaluation should not delay therapy. Sonographic signs of fetal or placental syphilis include, hepatomegaly, ascites, hydrops, fetal anemia, or a thickened placenta. This indicate a greater risk for fetal treatment failure. Such cases scenario are managed in consultation with obstetric specialists. Studies suggest that there is no specific regimens for such case scenario.
  • Women treated for syphilis during the second half of pregnancy are at risk for premature labor and/or fetal distress if the treatment precipitates the Jarisch-Herxheimer reaction . These women should be advised to seek obstetric attention after treatment if they notice any fever, contractions, or decrease in fetal movements. Stillbirth is a rare complication of treatment, but concern for this complication should not delay necessary treatment.
  • Missing doses in pregnancy is not acceptable and in such scenario therapy is repeated in full
  • While in pregnancy and you have syphilis HIV testing  should be offered.

Follow-Up

  1. Coordinated prenatal care and treatment are vital.
  2. At a minimum, serologic titers should be repeated at 28–32 weeks’ gestation and at delivery.
  3. Serologic titers can be checked monthly in women at high risk for reinfection or in geographic areas in which the prevalence of syphilis is high.
  4. Providers should ensure that the clinical and antibody responses are appropriate for the patient’s stage of disease.
  5. Inadequate maternal treatment is likely if delivery occurs within 30 days of therapy, clinical signs of infection are present at delivery, or the maternal antibody titrer at delivery is fourfold higher than the pretreatment titer.

Management of Sex Partners

Partner should be tested and treated for syphilis infection.

Special Considerations

Penicillin Allergy

  • No proven alternatives to penicillin are available for treatment of syphilis during pregnancy.
  • Pregnant women who have a history of penicillin allergy should be desensitized and treated with penicillin.
  • Skin testing or oral graded penicillin dose challenge might be helpful in identifying women at risk for acute allergic reactions.
  • Tetracycline and doxycycline are contraindicated in the second and third trimester of pregnancy .
  • Erythromycin and azithromycin should not be used, because neither reliably cures maternal infection or treats an infected fetus.
  • Data are insufficient to recommend ceftriaxone for treatment of maternal infection and prevention of congenital syphilis.

HIV Infection

  • Placental inflammation from congenital infection might increase the risk for perinatal transmission of HIV.
  • All women with HIV infection should be evaluated for syphilis and receive a penicillin regimen appropriate for the stage of infection.
  • Data are insufficient to recommend any alternative regimens for pregnant women with HIV infection.
About Docbobhe 26 Articles
Am Robert Mathenge, a healthcare provider in Nakuru county. i love this profession as it gives me chance to serve my call, interacting with people from various social backgrounds makes me feel good.

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