Syphilis in pregnancy (Monash Health)

Full video: Screening for syphilis in pregnancy at Monash Health

This full length video (13 minutes) covers information about:

• Rises in syphilis in pregnancy
• Why it matters and why we are testing routinely at 28 weeks
• How to test for syphilis
• Syphilis symptoms
• Interpreting a result
• Management of a positive result

If you would prefer to view specific sections, please see videos below.

Part 1. Syphilis, What is the problem?

The number of infections of syphilis in pregnant women have been increasing. As a result, infants have been born with congenital syphilis which can result in infant death. This is completely preventable!

Syphilis can be easily detected on a blood test and treated with antibiotics that are readily available and easy to administer. Further, evidence shows that detection and treatment of syphilis more than 4 weeks prior to delivery results in an almost 100% chance of preventing infection in the infant.

For this reason, offer syphilis screening serology as part of 28 week pathology to all women.

Part 2. Routine screening for syphilis

Offer syphilis screening to all women with routine 28 week pathology.

A script that can be used to do this is: “Syphilis is an infection that can affect your baby and has been increasing among Victorian women. But if we find it on this test, it can be easily treated for you and your baby.”

You can provide women with this pamphlet to explain syphilis testing in pregnancy.

Translated resources for CALD patients

Fact sheets about syphilis in Arabic, Chinese Simplified, Filipino, Japanese, Korean, Spanish, Thai and Vietnamese

Part 3. Symptomatic patients and additional testing

Syphilis can appear with, or without symptoms. Symptoms depend on stage of infection. Remember to ask about genital symptoms. Swab any genital lesion for herpes AND syphilis PCR.

If you would like to see some images of primary syphilis lesions, take a look at the STI atlas

Part 4. Interpreting a syphilis result

A positive syphilis PCR swab is confirmatory of infectious syphilis. Serology interpretation can be complex.

A clear syphilis history is required to interpret syphilis serology. This includes identifying prior infection, testing, treatment, partner management and symptoms.

Part 5. A positive result - what do I do?

1. Review our services guideline 
2. Interpret the result with support 
3. Take a syphilis history and document this in the patient record 
4. Treat the patient: Syphilis in pregnancy requires treatment with Benzathine Penicillin as soon as possible. Treatment depends on the stage of syphilis infection. 
5. Prevent reinfection by supporting identification, testing and treating of sexual partners

Part 6 Treatment partner management - Follow up

Chapters
Treatment: 0.00 – 1.02    |    Partner Management: 1.03 – 2.37   |    Follow Up: 2.40-end

Treatment is with IM Benzathine Pencillin. Treatment errors are common, so ensure that women have received the correct medication.

An essential element of syphilis management is testing and treatment of sexual partners. To support this there are a number of resources.

Mother and baby will require further follow up throughout pregnancy and birth. Use our service guideline on PROMPT to support this.