Abstract
Objective: The purpose of this study was to assess the effect of several maternal variables on the serologic response following the treatment of syphilis in pregnancy.
Methods: A 5-year chart review identified 95 patients coded with syphilis at Hermann Hospital. Inclusion criteria were 1) serologically confirmed syphilis infection during the index pregnancy, 2) complete treatment during the index pregnancy, and 3) minimum of one follow-up rapid plasma reagin (RPR) titer. Forty-nine of 95 patients met the inclusion criteria. Treatment response was evaluated by comparing each post-treatment titer of a patient to her pretreatment titer. Each comparison was considered an “observation.” Each observation was classified as either a positive response (≥4-fold titer decline) or a negative response (<4-fold titer decline). Maternal variables assessed included 1) prior history of syphilis untreated or incompletely treated prior to the index pregnancy, 2) gestational age, 3) titer level, 4) unknown duration, 5) positive response at 1 month, 6) positive response at 2 months, 7) positive response at >3 months, and 8) race.
Results: A positive response following treatment was significantly more likely if there was no prior history of syphilis or if there was a high initial RPR titer (>32). Only 33/54 (61%) observations at or greater than 3 months had a positive response.
Conclusions: Our study suggests that an absence of a history of syphilis and an initial high RPR titer are predictive of a positive response following appropriate treatment. Given the low percentage of observations with a positive response at 3 months, we speculate that we may be undertreating our pregnant patients with syphilis infection.
Full Text
The Full Text of this article is available as a PDF (461.8 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Borhanmanesh F., Haghighi P., Hekmat K., Rezaizadeh K., Ghavami A. G. Viral hepatitis during pregnancy. Severity and effect on gestation. Gastroenterology. 1973 Feb;64(2):304–312. [PubMed] [Google Scholar]
- Brown S. T., Zaidi A., Larsen S. A., Reynolds G. H. Serological response to syphilis treatment. A new analysis of old data. JAMA. 1985 Mar 1;253(9):1296–1299. [PubMed] [Google Scholar]
- Centers for Disease Control (CDC) Congenital syphilis--United States, 1983-1985. MMWR Morb Mortal Wkly Rep. 1986 Oct 10;35(40):625–628. [PubMed] [Google Scholar]
- Centers for Disease Control (CDC) Syphilis and congenital syphilis--United States, 1985-1988. MMWR Morb Mortal Wkly Rep. 1988 Aug 19;37(32):486–489. [PubMed] [Google Scholar]
- Diro M., Beydoun S. N. Malaria in pregnancy. South Med J. 1982 Aug;75(8):959-62, 968. doi: 10.1097/00007611-198208000-00014. [DOI] [PubMed] [Google Scholar]
- MAGNUSON H. J., THOMAS E. W., OLANSKY S., KAPLAN B. I., DE MELLO L., CUTLER J. C. Inoculation syphilis in human volunteers. Medicine (Baltimore) 1956 Feb;35(1):33–82. doi: 10.1097/00005792-195602000-00002. [DOI] [PubMed] [Google Scholar]
- Mascola L., Pelosi R., Alexander C. E. Inadequate treatment of syphilis in pregnancy. Am J Obstet Gynecol. 1984 Dec 15;150(8):945–947. doi: 10.1016/0002-9378(84)90387-9. [DOI] [PubMed] [Google Scholar]
- Morrow R. H., Jr, Smetana H. F., Sai F. T., Edgcomb J. H. Unusual features of viral hepatitis in Accra, Ghana. Ann Intern Med. 1968 Jun;68(6):1250–1264. doi: 10.7326/0003-4819-68-6-1250. [DOI] [PubMed] [Google Scholar]
- Nathan L., Bawdon R. E., Sidawi J. E., Stettler R. W., McIntire D. M., Wendel G. D., Jr Penicillin levels following the administration of benzathine penicillin G in pregnancy. Obstet Gynecol. 1993 Sep;82(3):338–342. [PubMed] [Google Scholar]
- SIEGEL M., GREENBERG M. Incidence of poliomyelitis in pregnancy; its relation to maternal age, parity and gestational period. N Engl J Med. 1955 Nov 17;253(20):841–847. doi: 10.1056/NEJM195511172532001. [DOI] [PubMed] [Google Scholar]
- Schroeter A. L., Lucas J. B., Price E. V., Falcone V. H. Treatment for early syphilis and reactivity of serologic tests. JAMA. 1972 Jul 31;221(5):471–476. [PubMed] [Google Scholar]
- Zenker P. N., Berman S. M. Congenital syphilis: trends and recommendations for evaluation and management. Pediatr Infect Dis J. 1991 Jul;10(7):516–522. [PubMed] [Google Scholar]