Syphilis in pregnancy
- Errol R Norwitz, MD, PhD, MBA
Errol R Norwitz, MD, PhD, MBA
- Professor and Chair
- Department of Obstetrics and Gynecology
- Tufts Medical Center and Tufts University School of Medicine
- Charles B Hicks, MD
Charles B Hicks, MD
- University of California, San Diego
- Section Editors
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
- Noreen A Hynes, MD, MPH, DTM&H
Noreen A Hynes, MD, MPH, DTM&H
- Section Editor — Sexually Transmitted Diseases
- Associate Professor of Infectious Diseases; International Health; and Population, Family, and Reproductive Health
- Johns Hopkins University Schools of Medicine and Public Health
- Deputy Editors
- Vanessa A Barss, MD, FACOG
Vanessa A Barss, MD, FACOG
- Senior Deputy Editor — UpToDate
- Deputy Editor — Obstetrics, Gynecology and Women's Health
- Associate Clinical Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- Jennifer Mitty, MD, MPH
Jennifer Mitty, MD, MPH
- Deputy Editor — Infectious Diseases
Syphilis is a systemic infection caused by the spirochete Treponema pallidum, which is of particular concern during pregnancy because of the risk of transplacental infection of the fetus. Congenital infection can be associated with several adverse outcomes, including perinatal death.
Issues related to syphilis during pregnancy will be reviewed here. Syphilis in children and nonpregnant adults are discussed separately. (See "Congenital syphilis: Clinical features and diagnosis" and "Congenital syphilis: Evaluation, management, and prevention" and "Syphilis: Epidemiology, pathophysiology, and clinical manifestations in HIV-uninfected patients" and "Syphilis: Treatment and monitoring".)
In the United States, the rate of primary and secondary syphilis in women increased from 0.9 cases per 100,000 females in 2012 and 2013 to 1.1 cases per 100,000 females in 2014 and to 1.4 cases per 100,000 females in 2015 , a 27.3 percent increase in the last year of reporting. Increases in syphilis among women is often followed by increases in congenital syphilis cases as most cases are in reproductive-aged women.
After a steady decline in congenital syphilis the rate of congenital syphilis has also increased 46 percent between 2012 and 2015, with 12.4 cases per 100,000 live births reported in 2015. Congenital syphilis rates were higher among infants born to black and Hispanic mothers (35.2 and 15.5 cases per 100,000 live births, respectively) compared with white mothers (4.4 cases per 100,000 live births).
Syphilis occurs with equal frequency in men and women worldwide , but men are more commonly infected in the United States. It is more common among pregnant women who are poor, young (age <29 years), African American, and lack health insurance and prenatal care. Other risk factors include use of illicit drugs, infection with other sexually transmitted diseases, residence in an area of high syphilis prevalence, and being a sex worker [3,4].
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- MATERNAL ACQUISITION OF INFECTION
- MATERNAL SCREENING
- Candidates and timing of initial and repeat screening
- Screening outside of traditional prenatal care
- Concurrent HIV screening
- Serological testing
- - Biologic false positive nontreponemal test due to pregnancy
- Primary syphilis
- Secondary syphilis
- Latent syphilis
- Tertiary (late) syphilis
- MATERNAL TREATMENT
- Treatment setting
- Preferred regimen: penicillin
- - Primary, secondary, or early latent disease
- - Late latent, tertiary, and disease of unknown duration
- Indications for retreatment
- - Neurosyphilis
- - Post-exposure prophylaxis
- Patients with immediate type allergic reactions to penicillin
- - Referral
- - Skin testing
- - Desensitization
- Use of non-penicillin regimens
- POTENTIAL COMPLICATIONS OF TREATMENT: JARISCH-HERXHEIMER REACTION
- POST-TREATMENT MATERNAL FOLLOW-UP
- Frequency and interpretation of nontreponemal titers
- - Diagnosis of treatment failure
- - Seroreversion and serofast states
- POTENTIAL ADVERSE PREGNANCY OUTCOMES
- VERTICAL TRANSMISSION
- Pathogenesis of congenital infection
- Factors influencing frequency of vertical transmission
- Prenatal diagnosis
- Fetal treatment and treatment failure
- Newborn evaluation and treatment
- PREGNANCY MANAGEMENT
- Antepartum fetal monitoring
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS