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
- John G Bartlett, MD
John G Bartlett, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — HIV; Pulmonary Infections
- Professor Emeritus
- Johns Hopkins University School of Medicine
- 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 is associated with several adverse outcomes [1-7], including:
●Low birth weight
- Ray JG. Lues-lues: maternal and fetal considerations of syphilis. Obstet Gynecol Surv 1995; 50:845.
- FIUMARA NJ, FLEMING WL, DOWNING JG, GOOD FL. The incidence of prenatal syphilis at the Boston City Hospital. N Engl J Med 1952; 247:48.
- Ricci JM, Fojaco RM, O'Sullivan MJ. Congenital syphilis: the University of Miami/Jackson Memorial Medical Center experience, 1986-1988. Obstet Gynecol 1989; 74:687.
- FIUMARA NJ. Congenital syphilis in Massachusetts. N Engl J Med 1951; 245:634.
- Watson-Jones D, Changalucha J, Gumodoka B, et al. Syphilis in pregnancy in Tanzania. I. Impact of maternal syphilis on outcome of pregnancy. J Infect Dis 2002; 186:940.
- Newman L, Kamb M, Hawkes S, et al. Global estimates of syphilis in pregnancy and associated adverse outcomes: analysis of multinational antenatal surveillance data. PLoS Med 2013; 10:e1001396.
- United States Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2015. http://www.cdc.gov/std/stats15/std-surveillance-2015-print.pdf (Accessed on November 22, 2016).
- Newman L, Rowley J, Vander Hoorn S, et al. Global Estimates of the Prevalence and Incidence of Four Curable Sexually Transmitted Infections in 2012 Based on Systematic Review and Global Reporting. PLoS One 2015; 10:e0143304.
- U.S. Preventive Services Task Force. Screening for syphilis infection in pregnancy: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med 2009; 150:705.
- ROCKWELL DH, YOBS AR, MOORE MB Jr. THE TUSKEGEE STUDY OF UNTREATED SYPHILIS; THE 30TH YEAR OF OBSERVATION. Arch Intern Med 1964; 114:792.
- Sparling PF. Natural history of syphilis. In: Sexually Transmitted Diseases, Holmes KK, Mardh PA, Sparling PF, et al (Eds), McGraw-Hill, New York 1990. p.213.
- Harman NB. Staying the Plague, Methuen & Co., LTD, London 1917.
- INGRAHAM NR Jr. The value of penicillin alone in the prevention and treatment of congenital syphilis. Acta Derm Venereol Suppl (Stockh) 1950; 31:60.
- Woolston S, Cohen SE, Fanfair RN, et al. A Cluster of Ocular Syphilis Cases - Seattle, Washington, and San Francisco, California, 2014-2015. MMWR Morb Mortal Wkly Rep 2015; 64:1150.
- Cheng JQ, Zhou H, Hong FC, et al. Syphilis screening and intervention in 500,000 pregnant women in Shenzhen, the People's Republic of China. Sex Transm Infect 2007; 83:347.
- National Evidence-Based Clinical Guidelines. Antenatal care: routine care for the healthy pregnant woman. www.rcog.org.uk/index.asp?PageID=693 (Accessed on March 28, 2006).
- Hossain M, Broutet N, Hawkes S. The elimination of congenital syphilis: a comparison of the proposed World Health Organization action plan for the elimination of congenital syphilis with existing national maternal and congenital syphilis policies. Sex Transm Dis 2007; 34:S22.
- Wolff T, Shelton E, Sessions C, Miller T. Screening for syphilis infection in pregnant women: evidence for the U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med 2009; 150:710.
- American College of Obstetricians and Gynecologists and American Academy of Pediatrics. Guidelines for Perinatal Care, 7th edition, 2012.
- Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64:1.
- Geusau A, Kittler H, Hein U, et al. Biological false-positive tests comprise a high proportion of Venereal Disease Research Laboratory reactions in an analysis of 300,000 sera. Int J STD AIDS 2005; 16:722.
- Tinajeros F, Grossman D, Richmond K, et al. Diagnostic accuracy of a point-of-care syphilis test when used among pregnant women in Bolivia. Sex Transm Infect 2006; 82 Suppl 5:v17.
- Albright CM, Emerson JB, Werner EF, Hughes BL. Third-Trimester Prenatal Syphilis Screening: A Cost-Effectiveness Analysis. Obstet Gynecol 2015; 126:479.
- ACOG Committee on Obstetric Practice. ACOG committee opinion number 304, November 2004. Prenatal and perinatal human immunodeficiency virus testing: expanded recommendations. Obstet Gynecol 2004; 104:1119.
- Fiumara NJ. Syphilis in newborn children. Clin Obstet Gynecol 1975; 18:183.
- Sheffield JS, Sánchez PJ, Morris G, et al. Congenital syphilis after maternal treatment for syphilis during pregnancy. Am J Obstet Gynecol 2002; 186:569.
- Mascola L, Pelosi R, Blount JH, et al. Congenital syphilis. Why is it still occurring? JAMA 1984; 252:1719.
- World Health Organization Guidelines for Treatment of Treponema Pallidum (syphilis) http://apps.who.int/iris/bitstream/10665/249572/1/9789241549806-eng.pdf?ua=1 (Accessed on September 15, 2016).
- Hollier LM, Harstad TW, Sanchez PJ, et al. Fetal syphilis: clinical and laboratory characteristics. Obstet Gynecol 2001; 97:947.
- Zhou P, Gu Z, Xu J, et al. A study evaluating ceftriaxone as a treatment agent for primary and secondary syphilis in pregnancy. Sex Transm Dis 2005; 32:495.
- Wendel GD Jr, Stark BJ, Jamison RB, et al. Penicillin allergy and desensitization in serious infections during pregnancy. N Engl J Med 1985; 312:1229.
- Johannes CB, Ziyadeh N, Seeger JD, et al. Incidence of allergic reactions associated with antibacterial use in a large, managed care organisation. Drug Saf 2007; 30:705.
- Saxon A, Beall GN, Rohr AS, Adelman DC. Immediate hypersensitivity reactions to beta-lactam antibiotics. Ann Intern Med 1987; 107:204.
- Yates AB. Management of patients with a history of allergy to beta-lactam antibiotics. Am J Med 2008; 121:572.
- Green GR, Rosenblum AH, Sweet LC. Evaluation of penicillin hypersensitivity: value of clinical history and skin testing with penicilloyl-polylysine and penicillin G. A cooperative prospective study of the penicillin study group of the American Academy of Allergy. J Allergy Clin Immunol 1977; 60:339.
- Klein VR, Cox SM, Mitchell MD, Wendel GD Jr. The Jarisch-Herxheimer reaction complicating syphilotherapy in pregnancy. Obstet Gynecol 1990; 75:375.
- Myles TD, Elam G, Park-Hwang E, Nguyen T. The Jarisch-Herxheimer reaction and fetal monitoring changes in pregnant women treated for syphilis. Obstet Gynecol 1998; 92:859.
- Fekade D, Knox K, Hussein K, et al. Prevention of Jarisch-Herxheimer reactions by treatment with antibodies against tumor necrosis factor alpha. N Engl J Med 1996; 335:311.
- Coxon RE, Fekade D, Knox K, et al. The effect of antibody against TNF alpha on cytokine response in Jarisch-Herxheimer reactions of louse-borne relapsing fever. QJM 1997; 90:213.
- Gudjónsson H, Skog E. The effect of prednisolone on the Jarisch-Herxheimer reaction. Acta Derm Venereol 1968; 48:15.
- Pound MW, May DB. Proposed mechanisms and preventative options of Jarisch-Herxheimer reactions. J Clin Pharm Ther 2005; 30:291.
- Remick DG, Negussie Y, Fekade D, Griffin G. Pentoxifylline fails to prevent the Jarisch-Herxheimer reaction or associated cytokine release. J Infect Dis 1996; 174:627.
- Rac MW, Bryant SN, McIntire DD, et al. Progression of ultrasound findings of fetal syphilis after maternal treatment. Am J Obstet Gynecol 2014; 211:426.e1.
- INCIDENCE AND EPIDEMIOLOGY
- CLINICAL FINDINGS
- Primary syphilis
- Secondary syphilis
- Tertiary syphilis
- Latent syphilis
- MATERNAL SCREENING
- False positives and false negatives
- PERINATAL TRANSMISSION
- Risk factors
- Pregnancy outcome
- Congenital syphilis
- - Placental findings
- - Fetal findings
- - Infant findings
- MATERNAL TREATMENT
- Preferred regimen: penicillin
- Use of alternative regimens
- Patients allergic to penicillin
- - Skin testing
- - Desensitization
- Jarisch-Herxheimer reaction
- Following titers after treatment
- OBSTETRICAL ISSUES
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS