Syphilis Management

Syphilis in Pregnancy

Screening Protocol

Universal Screening at 1st ANC
RPR / VDRL (Non-treponemal)
TPPA / TPHA (Treponemal Confirm)
Repeat at 28w & Delivery in high-risk

WHO/FIGO Treatment

Benzathine Penicillin G

2.4 Million Units (MU) IM

Congenital Prevention

Goal: Treatment > 30 Days before EDD

Jarisch-Herxheimer reaction risk: Warn patient & monitored especially in late pregnancy due to potential for uterine contractions and fetal distress.

Guidelines & Evidence

Verified

Last Review: 2026-07-17

When to Use

When to Screen

Universal screening at the first prenatal visit (required by law in most jurisdictions).

Rescreen at 28 weeks and at delivery for high-risk patients or those in high-prevalence areas.

Evaluation of any patient presenting with an unexplained maculopapular rash (palms/soles) or painless genital ulcer (chancre).

Mandatory workup for all cases of fetal hydrops or unexplained stillbirth.

Diagnosis Requirements

Diagnosis requires two-stage serologic testing: a nontreponemal test (RPR or VDRL) and a treponemal-specific test (TP-PA or FTA-ABS). A single positive test is insufficient due to potential biological false positives.

How it Works

Staging and Treatment Duration

Primary, Secondary, or Early Latent (<1 yr)	Benzathine Penicillin G 2.4M units IM x 1 dose
Late Latent (>1 yr) or Unknown Duration	Benzathine Penicillin G 2.4M units IM QWeek x 3 doses
Neurosyphilis	Aqueous Crystalline Penicillin G 18–24M units/day IV x 10–14 days

The Jarisch-Herxheimer Reaction

An acute febrile response occurring within 24 hours of starting treatment for syphilis. In pregnancy, this may trigger preterm labor or fetal distress (late decelerations) due to the massive release of treponemal lipopolysaccharides. This is NOT a penicillin allergy.

Last Comprehensive Review: 2026-07-17

Recent Journal Updates

PLOS MedicineJul 21, 2026

Adverse pregnancy outcomes and long-term risk of peripheral artery disease: A cohort study

Clinical Context

We think this might be relevant to the clinical guidance for Syphilis Management in Pregnancy.

Emerging Infectious DiseasesJul 17, 2026

Detection of Congenital Syphilis via Digital PCR and Next-Generation Sequencing, Colombia

Clinical Context

We think this might be relevant to the clinical guidance for Syphilis Management in Pregnancy.

British J Clinical PharmacologyJul 16, 2026

A British Pharmacological Society Position Statement on Medications in Pregnancy and Lactation

Clinical Context

We think this might be relevant to the clinical guidance for Syphilis Management in Pregnancy.

Syphilis Management

Syphilis in Pregnancy

When to Use

When to Screen

Diagnosis Requirements

How it Works

Staging and Treatment Duration

The Jarisch-Herxheimer Reaction

Clinical Pearls

Critical Management Pearls

Ultrasound Signs of Congenital Syphilis

Next Steps

Treatment Follow-Up

Neonatal Coordination

Associated Guidelines

The Evidence

Core Guidelines

Sexually Transmitted Infections Treatment Guidelines, 2021.

Evidence for Penicillin Superiority

Efficacy of treatment for syphilis in pregnancy.

Origins & History

The Resurgence of a Great Imitator

Historical Context

Recent Journal Updates

Syphilis Management

Syphilis in Pregnancy

When to Use

When to Screen

Diagnosis Requirements

How it Works

Staging and Treatment Duration

The Jarisch-Herxheimer Reaction

Clinical Pearls

Critical Management Pearls

Ultrasound Signs of Congenital Syphilis

Next Steps

Treatment Follow-Up

Neonatal Coordination

Associated Guidelines

The Evidence

Core Guidelines

Sexually Transmitted Infections Treatment Guidelines, 2021.

Evidence for Penicillin Superiority

Efficacy of treatment for syphilis in pregnancy.

Origins & History

The Resurgence of a Great Imitator

Historical Context

Recent Journal Updates