Warning:

This document is being maintained for historical purposes, but is now out of date. To view current guidelines please visit:

• STD Treatment Guidelines   at http://www.cdc.gov/STD/treatment

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1993 Sexually Transmitted Diseases Treatment Guidelines

09/24/1993

SUGGESTED CITATION
Centers for Disease Control and Prevention. 1993 Sexually
transmitted diseases treatment guidelines. MMWR 1993;42(No. RR-14):
{inclusive page numbers}.

CIO Responsible for this publication:
National Center for Prevention Services,
Division of Sexually Transmitted Diseases and HIV Prevention

Syphilis During Pregnancy
     
     All women should be screened serologically for syphilis during
the early stages of pregnancy. In populations in which utilization
of prenatal care is not optimal, RPR-card test screening and
treatment, if that test is reactive, should be performed at the
time a pregnancy is diagnosed. In communities and populations with
high syphilis prevalence or for patients at high risk, serologic
testing should be repeated during the third trimester and again at
delivery. (Some states mandate screening at delivery for all
women.) Any woman who delivers a stillborn infant after 20 weeks
gestation should be tested for syphilis. No infant should leave the
hospital without the serologic status of the infant's mother having
been determined at least once during pregnancy.

Diagnostic Considerations
     Seropositive pregnant women should be considered infected
unless treatment history is clearly documented in a medical or
health department record and sequential serologic antibody titers
have appropriately declined.

Treatment
     Penicillin is effective for preventing transmission to fetuses
and for treating established infection among fetuses. Evidence is
insufficient, however, to determine whether the specific,
recommended penicillin regimens are optimal.

Recommended Regimens -
     Treatment during pregnancy should be the penicillin regimen
     appropriate for the woman's stage of syphilis. Some experts
     recommend additional therapy (e.g., a second dose of benzathine
     penicillin 2.4 million units IM) 1 week after the initial dose,
     particularly for those women in the third trimester of pregnancy
     and for women who have secondary syphilis during pregnancy.

Other Management Considerations
     Women who are treated for syphilis during the second half of
pregnancy are at risk for premature labor or fetal distress, or
both, if their treatment precipitates the Jarisch-Herxheimer
reaction. These women should be advised to seek medical attention
following treatment if they notice any change in fetal movements or
if they have contractions. Stillbirth is a rare complication of
treatment; however, since therapy is necessary to prevent further
fetal damage, that concern should not delay treatment. All patients
with syphilis should be tested for HIV.

Follow-Up
     Serologic titers should be checked monthly until adequacy of
treatment has been assured. The antibody response should be
appropriate for the stage of disease.

Management of Sex Partners
     Refer to General Principles, Management of Sex Partners.

Special Considerations

Penicillin Allergy -
     There are no proven alternatives to penicillin. A pregnant
woman with a history of penicillin allergy should be treated with
penicillin, after desensitization, if necessary. Skin testing may
be helpful for some patients and in some settings (see Management
of the Patient With a History of Penicillin Allergy).
Tetracycline and doxycycline are contraindicated during pregnancy.
Erythromycin should not be used because it cannot be relied upon to
cure an infected fetus.

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