While timely treatment of syphilis is always desirable, treatment delay is particularly devastating in pregnancy: miscarriage, spontaneous abortion, fetal demise and congenital syphilis are all increased in pregnant women with untreated syphilis. Alternatives to penicillin for syphilis treatment in pregnant women were explored, however, due to reports of treatment failure and toxicity concerns, penicillin remains the only recommended therapy for syphilis in pregnant women. In situations of penicillin allergy, consultation and appropriate penicillin desensitization should be performed, followed immediately by appropriate therapy. Despite the widespread misperception that 2 (or more) weeks of penicillin are required for effective early syphilis therapy in pregnant women, the recommended dosing and schedule for syphilis therapy in pregnancy is the same as for non-pregnant patients. Ideally, diagnosis and treatment of syphilis in pregnant women should occur during the first or second trimester; worse pregnancy outcomes were associated with syphilis care initiated in the third trimester. Therapy occurring during or later than the second trimester should be accompanied by fetal evaluation by ultrasound where available. Delivery less than 30 days after maternal therapy, rising maternal antibody titers (≥fourfold increase from initial testing) and/or clinical signs/symptoms at the time of delivery may by indicative of inadequate therapy.
Expert Rev Anti Infect Ther. 2013;11(8):839-843. © 2013 Expert Reviews Ltd.