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Footnote
<sup>1</sup> Penicillin G is the only known effective tx for preventing transmission to the fetus and for fetal infxn; if penicillin allergic, desensitize and treat w/ penicillin.<br><br>
<sup>2</sup> Some providers treat pts who have cardiac syphilis w/ a neurosyphilis regimen.
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<sup>3</sup> Missed doses are not acceptable for pregnant pts receiving tx for latent syphilis. Pts who miss any dose of tx must repeat the full course.
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<sup>4</sup> Limited data available on clinical response and f/u of 3° syphilis.
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<sup>5</sup> Placental inflammation from congenital infxn might increase risk for perinatal transmission of HIV.
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<sup>6</sup> Sonographic signs of fetal/placental syphilis (ie, hepatomegaly, ascites, hydrops, fetal anemia, or a thickened placenta) indicate a greater risk for fetal tx failure; manage in consultation w/ OB. Evidence insufficient to recommend specific regimens for these situations.
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<sup>7</sup> Inadequate tx in the pregnant pt is likely if delivery occurs w/in 30 days of tx, clinical signs of infxn present at delivery, or Ab titer in the pregnant pt at delivery is 4-fold higher than pre-tx titer.
<sup>2</sup> Some providers treat pts who have cardiac syphilis w/ a neurosyphilis regimen.
<br><br>
<sup>3</sup> Missed doses are not acceptable for pregnant pts receiving tx for latent syphilis. Pts who miss any dose of tx must repeat the full course.
<br><br>
<sup>4</sup> Limited data available on clinical response and f/u of 3° syphilis.
<br><br>
<sup>5</sup> Placental inflammation from congenital infxn might increase risk for perinatal transmission of HIV.
<br><br>
<sup>6</sup> Sonographic signs of fetal/placental syphilis (ie, hepatomegaly, ascites, hydrops, fetal anemia, or a thickened placenta) indicate a greater risk for fetal tx failure; manage in consultation w/ OB. Evidence insufficient to recommend specific regimens for these situations.
<br><br>
<sup>7</sup> Inadequate tx in the pregnant pt is likely if delivery occurs w/in 30 days of tx, clinical signs of infxn present at delivery, or Ab titer in the pregnant pt at delivery is 4-fold higher than pre-tx titer.
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Perform CSF exam in all pts w/ 3° syphilis