treatment

Last edited 07/2020

Mother:

• 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