Practical Issues Related to Screening for and Treatment of Syphilis

Syphilis is a largely ignored maternal and perinatal health problem in many developing countries. Newman et al. (2013) estimates that syphilis is responsible for 520,000 adverse pregnancy outcomes, including 215,000 stillbirths or early fetal deaths, 90,000 neonatal deaths, 65,000 LBW or premature infants, and 150,000 infected newborns. Congenital syphilis can cause mental retardation and other neurological problems. The study states, “The vast majority of outcomes that occurred in 2008 could have been prevented had the women received quality early ANC that included syphilis testing and access to effective therapies, as recommended by WHO.”[i]

Recently, relatively inexpensive rapid strip tests for syphilis became available and now testing can be carried out by ANC providers. WHO recommends a single dose of 2.4 million units of benzathine penicillin G for recently acquired syphilis and a three-week course of 7.2 million units if the person has had syphilis at least one year. The woman’s sexual partner should also be treated to prevent reinfection. Ideally, women should be tested twice, once in early pregnancy and once during the final stages of the third trimester.

WHO recommends that an asymptomatic neonate born to a venereal disease research laboratory (VDRL) or rapid plasma reagin (RPR) test positive mother should receive 50,000 units/kg of benzathine benzyl penicillin in a single intramuscular dose. Symptomatic infants are noted as LBW; palms and soles with red rash, gray patches, blisters or skin peeling; snuffles or rhinitis with nasal obstruction, which is highly infectious; and abdominal distention due to big liver and spleen; jaundice; and anemia. Some VLBW babies with syphilis have signs of severe sepsis with lethargy, respiratory distress, skin petechiae or other bleeding. These symptomatic infants should receive procaine benzyl penicillin 50,000 units per kg as a single dose daily for 10 days or benzyl penicillin 50,000 units per kg every 12 hours intramuscular or intravenous for the first seven days of life, and then every 8 hours for the next 3 days.[ii]

Key Resources for Syphilis:

[i] Newman, L., et al. Global Estimates of Syphilis in Pregnancy and Associated Adverse Outcomes: Analysis of Multinational Antenatal Surveillance Data, Plos Med;2013. DOI: 10.1371/journal.pmed.1001396

[ii] WHO, 2005. Pocket book of hospital care for children.