Syphilis

Syphilis is a treatable infection caused by Treponema pallidum, a motile spirochete. In the pregnant woman, infection is most often sexually transmitted. The infection is described in four stages: primary, secondary, latent, and tertiary or late. It is rare to see pregnant women in tertiary or late syphilis (Sheffield and Wendel, 1999).

Pregnancy has little effect on the course of syphilis, but syphilis has a substantial effect on pregnancy and the fetus. Stages with spirochetemia are the most deleterious for the fetus. This is most often seen in late primary syphilis and in secondary syphilis. An increase in miscarriage, hydrops fetalis, stillborn, and preterm delivery of an infected fetus can be seen. Penicillin is the only antibiotic currently recommended for syphilis treatment in pregnancy because of its safety, efficacy, and transplacental passage to treat

Table 21-6 Drugs and Exposures in Pregnancy

Agent

Recommendation

Comments

Antihistamines

Acceptable

Most are category B.

Decongestants

Acceptable

Pseudoephedrine preferred.

Cough medication with guaifenesin

Acceptable

Acetaminophen

Acceptable

Preferred analgesic and antipyretic.

Aspirin

Avoid

Increases risk of bleeding; no benefit in preeclampsia; may be prescribed in low doses for specific conditions.

NSAIDs

Avoid

Premature closure of ductus arteriosus.

Cephalosporins

Acceptable

Sulfonamides

Avoid in third trimester.

Kernicterus in newborn.

Tetracyclines

Avoid

Discoloration of teeth.

ACE inhibitors

Avoid

Stillborn, renal abnormalities, renal failure in newborn.

Immunizations

Avoid live, attenuated viruses.

Measles, mumps, rubella.

Allergy shots

Acceptable

Alteration in maintenance dose may be necessary.

Modified from Hueston WJ, Eolers GM, King DE, McGlaughlin VG. Common questions patients ask during pregnancy. Am Fam Physician 1995;51:1465-1470. ACE, Angiotensin-converting enzyme; NSAIDs, nonsteroidal anti-inflammatory drugs.

the fetus (CDC, 1999). Penicillin-allergic women should undergo desensitization first. Whenever treatment adequacy is questioned in pregnancy, repeat therapy should occur because congenital syphilis is a preventable disorder. All women with syphilis should be carefully evaluated for other STDs, in particular HIV, as the treatment and surveillance is different in co-infection and the possibility of neurosyphilis must be carefully evaluated.

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