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  6. Positive syphilis serology in pregnancy
  7. Background to key points in diagnosis and management
Important: please update your RDS app to version 4.7.3 Details with newsletter below.

Please update your RDS app to v4.7.3

We asked you in January to update to v4.7.2.  After the deployment planned for 27th February, this new update will be needed to ensure that you are able to download RDS toolkits even when the RDS website is not available. We will wait until as many users as possible have downloaded the new version before switching off the old system for app downloads and moving entirely to the new approach.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. 

To update to the latest release:

 On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Right Decision Service newsletter: February 2025

Welcome to the February 2025 update from the RDS team

1.     Next release of RDS

 

A new release of RDS is planned (subject to outcomes of current testing) for week beginning 24th February. This will deliver:

 

  • Fixes to mitigate the recurring glitches with the RDS admin area and the occasional brief user interface outages which have arisen following implementation of the new distributed technology infrastructure in December 2024.

 

  • Capability to embed content from Google calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream into RDS pages.

 

  • Capability to include simple multiplication in RDS calculators.

 

The release will also incorporate a number of small fixes, including:

  • Exporting of form within Medicines Sick Day Guidance in polypharmacy toolkit
  • Links to redundant content appearing in search in some RDS toolkits
  • Inclusion of accordion headers alongside accordion text in search result snippets.
  • Feedback form on mobile app.
  • Internal links on mobile app version of benzo tapering tool

 

We will let you know when the date and time for the new release are confirmed.

 

2.     New RDS developments

There is now the capability to publish toolkits on the web with left hand side navigation rather than tiles on the homepage. To use this feature, turn on the “Toggle navigation panel” option at the top of the Page settings menu at toolkit homepage level – see below. Please note that publication to downloadable mobile app for this type of navigation is still under development.

The Benzodiazepine tapering tool (https://rightdecisions.scot.nhs.uk/benzotapering) is now available as part of the RDS toolkit for the national benzodiazepine prescribing guidance developed by the Scottish Government Effective Prescribing team. The tool uses this national guidance developed with a wide-ranging multidisciplinary group. This should be used in combination with professional judgement and an understanding of the needs of the individual patient.

3.     Archiving and version control and new RDS Search and Browse interface

Due to the intensive work Tactuum has had to undertake on the new technology infrastructure has pushed back the delivery dates again and some new requirements have come out of the recent user acceptance testing. It now looks likely to be an April release for the search and browse interface. The archiving and version control functionality may be released earlier. We’ll keep you posted.

4.     Statistics

At the end of January, Olivia completed the generation of the latest set of usage statistics for all RDS toolkits. If you would like a copy of the stats for your toolkit, please contact Olivia.graham@nhs.scot .

 

5.     Review of content past its review date

We have now generated reports of all RDS toolkit content that has exceeded its review date by 6 months or more. We will be in touch later this month with toolkit owners and editors to agree the plan for updating or withdrawing out of date content.

 

6.     Toolkits in development

Some important toolkits in development by the RDS team include:

  • National CVD prevention pathways – due for release end of March 2025.
  • National respiratory pathways, optimal cancer diagnostic pathways and cancer prehabilitation pathways from the Centre for Sustainable Delivery. We will shortly start work on the national cancer referral pathways, first version due for release via RDS around end of June 2025.
  • HIS Quality of Care Review toolkit – currently in final stages of quality assurance.

 

The RDS team and other information scientists in HIS have also been producing evidence summaries for the Scottish Government Realistic Medicine team, to inform development of national guidance around Procedures of Limited Clinical Value. This guidance will in due course be translated into an RDS toolkit.

 

7. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

  • Friday 28th February 12-1 pm
  • Tuesday 11th March 4-5 pm

 

To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)

 

To invite colleagues to sign up to receive this newsletter, please signpost them to the registration form  - also available in End-user and Provider sections of the RDS Learning and Support area.   If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot  If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.

With kind regards

 

Right Decision Service team

Healthcare Improvement Scotland

 

 

Background to key points in diagnosis and management

Warning

Key point 1

Syphilis in pregnancy should be managed as clinically urgent

 

  • In pregnant women with untreated early syphilis 70-100% of infants will be infected, with still births occurring in up to one third of cases.
  • Infection in pregnancy can cause intra uterine growth retardation, stillbirth, hydrops fetalis, or premature delivery.
  • Babies born with congenital syphilis can have early manifestations of the disease (within the first 2 years of life) or late manifestations (after 2 years of life) including the stigmata of congenital syphilis.
  • Although fetal infection usually occurs late in pregnancy it has been demonstrated as early as 8-9 weeks gestation.
  • Prompt treatment reduces the risk of spread to the fetus.

 

Key point 2

Syphilis should always be considered as a possible cause of an anogenital ulcer

 

  • Serology can be negative in the early stage of syphilis and any concerns should be discussed with Sexual Health.
  • Risk factors for syphilis in pregnant women include belonging to an ethnic minority group, having been born abroad and having a male sexual partner who has sex with men.
  • In addition, asymptomatic patients with initial negative serology but who are either considered to have on going risk of syphilis or risk in the 3 months leading up to initial serology should be retested later in pregnancy.
  • Prompt treatment reduces the risk of spread of the infection to the fetus and this should be taken into account when planning the timing of repeat tests.

 

Key point 3

Pregnant women with positive antenatal syphilis serology should be discussed urgently with sexual health services

 

It is the responsibility of the patient’s Obstetric team to directly inform by telephone a Sexual Health doctor  that a patient has positive syphilis serology.

NHS D&G screen with a combined IgM and IgG Enzyme Immunoassay (EIA). Since biological false positive results are common during pregnancy accounting for about ¼ of positive screening tests, ‘reactive results’ are not communicated to clinicians until reference laboratory confirmation is obtained.

Specimens reactive at NHS D&G using EIA screening test are forwarded to the Reference Laboratory in Edinburgh. The Reference Lab tests using different treponemal tests (TPPA) and a quantitative non treponemal test (RPR). A positive syphilis report is one which has been confirmed at the Reference Lab.

All syphilis serology results should be available within 2 weeks. A second sample should be sent to the microbiology laboratory for all patients with a positive result. Sexual Health may request this sample is taken by obstetric staff if there is expected to be a delay of more than 2 working days before the patient is seen (clinical details: urgent for reference lab, pregnant, previous positive serology).

On receipt of the referral the Sexual Health doctor will phone the patient to explain the purpose of the visit and answer any immediate questions.

 

Key point 4

Priority should be given to ensuring syphilis serology results from patients who book from 24 weeks of pregnancy are available as soon as possible.

 

Key point 5

Women with positive syphilis serology (excluding biological false positive screening test) should receive prompt treatment unless there is clear documented previous syphilis treatment (as recommended by current UK guidelines) with supporting serological evidence of response to treatment.

 

Sexual Health will fully explore this with the pregnant woman, the Obstetric team and, where relevant and with her permission, other clinicians currently or previously involved in her care.

Treatment ideally should only take place once the first positive result has been confirmed on a second sample but may need to take place with second result pending depending on patient history and gestation.

Women with documented previous syphilis treatment (as recommended by current UK guidelines) with supporting serological evidence of response to treatment should have repeat serology sent to the reference laboratory in Edinburgh around 28 weeks gestation to exclude reinfection.

 

Key point 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.

 

Syphilis staging takes into account the patients history, current (and if available previous serological results), and clinical examination with particular emphasis on the skin, genitals, lymph nodes and mucosa. Cardiovascular and neurological examination is required in late syphilis and those with relevant symptoms.

Treatment is individualised depending on the stage of infection and normally involves administration of parental drugs. Treatment will either be prescribed/administered by Sexual Health or the woman’s obstetric or primary care team based on Sexual Health recommendations.

Syphilis serology should always be repeated on the first day of treatment to allow serological response to treatment to be monitored.

Patients receiving syphilis treatment require follow up to detect reinfection or relapse by assessing clinical and serological response to treatment. Sexual Health will either arrange follow up visits within their service or liaise with the women’s obstetric team for the follow up serology to be taken during routine antenatal care visits.

 

Key point 7

Fetal scanning before and fetal monitoring during treatment may be necessary

 

When syphilis is diagnosed during the second half of pregnancy, management should include detailed US evaluation but this should not delay treatment. Ultrasound signs of fetal or placental syphilis indicate a greater risk for fetal treatment failure. There is a risk of a Jarisch-Herxheimer reaction to treatment at some stages of infection and this may lead to fetal distress and premature labour.

In some cases patients may require to be admitted to the antenatal unit for syphilis treatment. The need for admission will be based on the gestation of pregnancy, the stage of syphilis, the serology (in particular the RPR) and the travel time between home and Dumfries Royal Infirmary or the Galloway Community Hospital. All women need to be advised to seek obstetric attention after treatment if they notice fever, contractions, or decrease in fetal movements.

 

Key point 8

Partner notification is essential to reduce the possibility of re-infection of a pregnant woman (and unborn child)

 

  • Partner notification is a voluntary process.
  • It would be anticipated that with appropriate counselling pregnant women would engage with this process to avoid re-infection of themselves (and their unborn child).
  • Partner notification may include both current and previous partners, the ‘look back’ period depending on the stage of infection.
  • Immediate epidemiological treatment for current sexual partner(s) may be appropriate.
  • Partner notification will be explored by sexual health with the pregnant woman.

 

Key point 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.

 

Babies should be fully assessed (both clinically and serologically) by a paediatrician and decisions made will include whether the baby requires further treatment and or follow up.

 

Key point 10

All parties involved in the care of pregnant women with syphilis (Sexual Health, case holding obstetric consultant, community midwifery team, paediatric team and GP) should be included in all relevant correspondence.

 

The details of the case holding obstetric consultant are available from the community midwifery team or the antenatal clinic reception 01387 241200.

 

Editorial Information

Last reviewed: 31/01/2026

Next review date: 31/01/2026

Author(s): Sexual Health D&G.

Version: 2023

Approved By: JOINTLY AGREED BY MICROBIOLOGY, MATERNITY, PAEDIATRIC & SEXUAL HEALTH SERVICES DUMFRIES & GALLOWAY