This protocol applies to patients with latent syphilis confirmed as early stage — that is, acquired within the past 2 years — who are currently pregnant. The combination of active pregnancy and the early stage of infection defines a specific clinical pathway distinct from other presentations.
For patients without a confirmed history of prior syphilis treatment, staging as early or late is essential: the recommended regimen differs depending on time since acquisition. Treatment should follow the stage of disease in line with established national guidelines, with pregnancy introducing additional considerations around agent choice and dosing schedule.
Standard benzathine penicillin G is the cornerstone of management. The specific pathway — including how trimester timing and penicillin allergy history shape the approach — is covered in full within the protocol.
The primary serological target following treatment is a four-fold drop in RPR titre. This response may take several months to become apparent, and in many pregnancies delivery will occur before it is observed.
For those without a confirmed history of treatment, syphilis should be staged as early (within 2 years of acquisition) or late (more than 2 years since acquisition) in order to determine the recommended penicillin regimen.
Patients should be treated appropriately for the stage of disease, according to the BASHH UK national guidelines on the management of syphilis 2023.
In the absence of allergy to penicillin, standard benzathine penicillin G treatment should be given.
It may take several months to observe a 4-fold drop in RPR titre and in many pregnancies delivery will occur beforehand.
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