Aims and key points

To detect and treat maternal syphilis as early as possible to minimise the risk of syphilis related illness to the mother, syphilis infection in the fetus and to prevent still birth, premature delivery and congenital syphilis in the newborn.

1. Syphilis in pregnancy should be managed as clinically urgent.
2. Syphilis should always be considered as a possible cause of an anogenital ulcer.
3. Pregnant women with positive antenatal syphilis serology should be discussed urgently with sexual health services.
4. Priority should be given to ensuring syphilis serology results from women who book from 24 weeks of pregnancy are available as soon as possible.
5. Women with positive syphilis serology should receive prompt treatment unless syphilis has been cured prior to pregnancy or the result is considered to be a biological false positive.
6. A pregnant woman’s treatment should be appropriate for the stage of syphilis diagnosed with comprehensive follow up to minimise the likelihood of her developing long term complications of untreated/inadequately treated syphilis.
7. Fetal scanning before and fetal monitoring during treatment may be necessary.
8. Partner notification is essential to reduce the possibility of re-infection of a pregnant woman (and unborn child).
9. Arrangements should be made for pregnant women who have positive syphilis serology (excluding biological false positives or syphilis treated prior to pregnancy with documented serological response to treatment and reinfection excluded) to see a member of the paediatric team who will be involved in the care of the baby after delivery.
10. All parties involved in the care of pregnant women with syphilis (for example sexual health, case holding obstetric consultant, community midwifery team, paediatric team and GP) should be included in all relevant correspondence.