if evidence of maternal infection during pregnancy then expert advice should be sought
management of syphilis in pregnant women
women requiring treatment for syphilis are treated by the sexual health specialist and are retested later in pregnancy for syphilis as part of this clinical management
primary, secondary and early latent syphilis are treated with benzathine penicillin G (BPG) as a single muscular injection. Late latent syphilis is treated with the same dose weekly for 3 weeks with no more than 7 days between doses (1)
Neonate:
seek expert advice
in infants born with congenital syphilis (CS), the infection can cause reduced growth and development, and result in neurological impairment, bone deformities and hearing loss (2,3)
benzyl penicillin sodium (intravenous) is used to treat CS in neonates. Treatment is given for ten days with 30 mg/kg doses given 12-hourly for the first seven days and 8-hourly for the subsequent three days (1,4)
infants are likely to then have monitoring beyond the completion of treatment. Infants treated in the first two months of life have a good short-term prognosis, but the long-term prognosis for infants treated for CS at birth or treated later, due to delayed diagnosis, have not been reported (5,6)
evidence indicates that most infants with CS develop signs by 5 weeks, however, there is a lack of data on the proportion of CS cases with late presentation (after 2 years) (1)
Reference:
1) Sheffield JS, Sánchez PJ, Morris G, et al. Congenital syphilis after maternal treatment for syphilis during pregnancy. Am J Obstet Gynecol 2002;186:569–73. doi:10.1067/mob.2002.121541
2)Gomez GB, Kamb ML, Newman LM, et al. Untreated maternal syphilis and adverse outcomes of pregnancy: a systematic review and meta-analysis. Bull World Health Organ 2013;91:217–26. doi:10.2471/BLT.12.107623
3)De Santis M, De Luca C, Mappa I, et al. Syphilis Infection during Pregnancy: Fetal Risks and Clinical Management. Infect Dis Obstet Gynecol 2012;2012. doi:10.1155/2012/430585
4) Kingston M, French P, Fifer H, et al. Congenital syphilis in England and amendments to the BASHH guideline for management of affected infants. Int J STD AIDS 2017;28:1361–2. doi:10.1177/0956462417733866
5) Arnold SR, Ford-Jones EL. Congenital syphilis: A guide to diagnosis and management. Paediatr Child Health 2000;5:463–9.
6) Mwaniki MK, Atieno M, Lawn JE, et al. Long-term neurodevelopmental outcomes after intrauterine and neonatal insults: a systematic review. Lancet 2012;379:445–52. doi:10.1016/S0140-6736(11)61577-8
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