Syphilis in pregnancy

The incidence of Syphilis has increased by 607% from 2000 to 2009. Syphilis is a complex systemic disease that may be classified as acquired or congenital. In pregnancy syphilis should be managed as clinically urgent. In pregnant women with untreated early syphilis 70-100% of infants will be infected. A 23-year-old primigravida presented at booking to Mid Cheshire Hospital Trust and her subsequent bloods demonstrated that she was Treponemal EIA positive. Repeat serology confirmed this and IgM EIA was found to be positive. Results where consistent with recent or active syphilis infection. A multidisciplinary team approach was adopted and the patient was seen urgently in the genitourinary medicine clinic for further screening. The remainder of the booking serology where normal. The patient was treated with Azithromycin. Subsequent follow up in the GUM clinic to monitor titres where arranged. Fetal surveillance was also undertaken regularly in the Fetal Medicine Unit. Complex social issues and non-compliance, particularly in encouraging the patient to attend the GUM clinic for titres, complicated the case. Opportunistic titres where performed and suggested a suboptimal response to treatment and the patient was given a further course of Azithromycin for 10 days at 38 weeks. The pregnancy was complicated further with recurrent admissions for urinary sepsis and the patient was delivered by elective section at 39/40 for a breech presentation. The paediatric team reviewed the infant following delivery and appropriate investigations, treatment and follow up were arranged.