Original Articles
Efficacy of treatment for syphilis in pregnancy

https://doi.org/10.1016/S0029-7844(98)00338-XGet rights and content

Abstract

Objective: To evaluate prospectively the Centers for Disease Control and Prevention (CDC) recommended regimens for the treatment of antepartum syphilis and prevention of congenital syphilis.

Methods: This was a prospective evaluation of recommended syphilis treatment regimens from September 1, 1987, to August 31, 1989, at Parkland Memorial Hospital, Dallas, Texas. Women with syphilis were staged and treated according to CDC recommendations. Treatment included 2.4 million units of intramuscular (IM) benzathine penicillin G for primary, secondary, or early latent (less than 1 year) syphilis. Women with late latent (uncertain or longer than 1 year) syphilis were treated with 7.2 million units of benzathine penicillin G IM over 3 weeks.

Results: During the study period, 448 of 28,552 women (1.6%) delivered were diagnosed with syphilis. One hundred eight were diagnosed at delivery and treated postpartum. The remaining 340 (75.9%) gravidas with untreated syphilis attending prenatal clinic comprised the study group. The success of therapy in preventing congenital syphilis was as follows: primary syphilis, 27 of 27; secondary syphilis, 71 of 75; early latent syphilis, 100 of 102; and late latent syphilis, 136 of 136. The success rate for all stages of syphilis was 334 of 340 (98.2%). The success rate of therapy in secondary syphilis was significantly different from that of the other groups (P = .03). Two of the six fetal treatment failures produced preterm stillborns. Only one maternal treatment failure occurred, in a human immunodeficiency virus-infected woman.

Conclusion: The CDC-recommended regimens for the prevention of congenital syphilis and treatment of maternal infection are effective, but the highest risk of fetal treatment failure exists with maternal secondary syphilis.

Section snippets

Materials and methods

This was a prospective clinical trial from September 1, 1987, to August 31, 1989, including all women who delivered at Parkland Memorial Hospital in Dallas, Texas, approved by the University of Texas Southwestern Institutional Review Board. Subjects were identified through the Dallas County Hospital District prenatal system by maternal syphilis serologic screening (first prenatal visit, 28–32 weeks prenatal visit, and at delivery), the Parkland Memorial Hospital Emergency Room, or Dallas County

Results

During the 2-year study period, 28,552 women delivered at Parkland Memorial Hospital. Seven hundred forty-six had positive serologic tests for syphilis, and 298 of these were identified as having sero-fast serologic tests. Four hundred forty-eight women (1.6% of the population) had untreated syphilis, of those 340 (75.9%) received prenatal care and antepartum therapy (Table 1).

The mean age of women with untreated syphilis was 24 years, and the mean gestational age at diagnosis was 32 weeks.

Discussion

A resurgence of congenital syphilis in the 1980s led to questions about the adequacy of the CDC guidelines for treatment of maternal syphilis and prevention of neonatal infection. Several factors contributed to the increase in congenital syphilis, including increased incidence of maternal disease, failure to detect maternal disease, noncompliance with treatment recommendations, and fetal treatment failure. Lack of prenatal care leading to failure to identify and treat maternal infection

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Supported by grant R30/CCR 602742 from the Public Health Service and Centers for Disease Control and Prevention.

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