Case 40 - A 20-Year-Old with Positive Rapid Plasma Reagin on Initial Prenatal Labs

Summary

Once thought to be on target for eradication, syphilis prevalence is on the rise. Syphilis in pregnancy constitutes a significant risk to the health of mothers and infants. Screening should be performed for all pregnant individuals, though no single definitive laboratory test is widely available. Treponemal and nontreponemal tests are utilized in multistep algorithms to distinguish false from true-positive results and active from past infection. Provider familiarity with these algorithms allows for accurate diagnosis and treatment. Positive test results must be reported to local health officials. Duration of infection and disease sequalae determines categorization into primary, secondary, tertiary, and latent disease. Treatment of syphilis during pregnancy requires the administration of benzathine penicillin G even in penicillin allergic patients. Two or three doses of 2.4 million units intramuscularly are often indicated. Fetal assessment should include detailed ultrasound. Close follow-up is vital to successful risk mitigation and often involves the treatment of partners and infants.