Syphilis in pregnancy:

Facts

Screen all pregnant women at the first prenatal encounter with serologic testing.

But women at high risk of infection need rescreening at 28-32 weeks and at delivery.

Treatment: Penicillin G benzathine

Jarisch-Herxheimer reaction: An acute febrile reaction precipitated by the treatment of syphilis consisting of headache, myalgia, rash and hypotension. It is due to the release of large amounts of treponemal lipopolysaccharide from dying spirochetes. Counsel all patients about JHR. Management is supportive care with antipyretics and IV fluids.

Adverse pregnancy outcomes: Miscarriage, preterm birth, stillbirth, impaired fetal growth, congenital infection, neonatal mortality.

-Treponema pallidum infections the placenta (transplacental transmission to the fetus can occur around 9th to 10th week of gestation)

-Classic radiographic appearance of pneumonia in infants with congenital syphilis: Complete opacification of both lung fields (‘pneumonia alba’)

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