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Syphilis in pregnancy treatment — DTM&H MCQ

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HardTropical Bacterial InfectionsSyphilis in pregnancy treatmentDTM&H

A pregnant woman has reactive treponemal and non-treponemal tests, no symptoms, no reliable date of acquisition and no documented previous treatment. There is no evidence of neurosyphilis. What is the appropriate regimen?

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Correct answer: A — Benzathine penicillin G 2.4 million units intramuscularly weekly for three doses

The best answer is “Benzathine penicillin G 2.4 million units intramuscularly weekly for three doses”. With no evidence that infection was acquired recently, this is latent syphilis of unknown duration and should be treated as late latent disease. Pregnancy makes penicillin essential; allergy would require desensitisation rather than doxycycline or azithromycin. A single dose is for early syphilis, while intravenous benzylpenicillin is reserved for neurosyphilis or other specific indications.

Reference: WHO guideline on syphilis screening and treatment for pregnant women: https://iris.who.int/bitstream/handle/10665/259003/9789241550093-eng.pdf