​Congenital Syphilis for Providers

Testing Recommendations

In response to the recent increase in early syphilis especially in individuals of child-bearing age, the PADOH is recommending that all pregnant individuals be offered a test for syphilis at the following intervals:

• At the first prenatal visit,
• At the third trimester of pregnancy,
• At the delivery of a child, or
• At the delivery of a stillborn child.

The statewide requirement for syphilis testing contained in 28 Pa Code § 27.89 (a)(1)(i) directs a physician who attends, treats, or examines a pregnant woman for conditions relating to pregnancy to offer the woman a test for syphilis at the time of first examination.

If a pregnant woman does not object, the test shall be performed in accordance with 28 Pa Code §27.89. If a pregnant woman objects, the regulation requires the person attending the woman to explain to her the need for the test. With respect to the woman who has given birth, information relating to the test or the objection to the test is to be recorded in both the woman's medical record and in the record of the newborn, as regulation states.

In addition, all patients presenting with any of the following symptoms or conditions should be tested for syphilis:

• A macular and/or papular rash on the palms of the hands or on the soles of the feet
• A generalized rash that may be macular, papular, or papulosquamous on the back, chest, or stomach
• A lesion in the genital, rectal, or oral area
• Moist papules in the anogenital region or the mouth
• Sudden "Moth-eaten" scalp alopecia with a typical onset at the back of the head
• Loss of eyelashes and the lateral third of the eyebrows 
• Generalized lymphadenopathy
• Malaise
• A recent positive test for another sexually transmitted disease such as gonorrhea or chlamydia

Treatment Recommendations

1. Primary, secondary, and early latent: adults (including pregnant women and people with HIV infection) benzathine penicillin G 2.4 million units IM in a single dose.
2. Late latent adults (including pregnant women and people with HIV infection) benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervals.
3. Neurosyphilis, ocular syphilis, and otosyphilis aqueous crystalline penicillin G 18–24 million units per day, administered as 3–4 million units by IV every 4 hours or continuous infusion, for 10–14 days procaine penicillin G 2.4 million units IM 1x/day PLUS probenecid 500 mg orally 4x/day, both for 10–14 days.
4. Parenteral Benzathine penicillin G is the only therapy with documented efficacy for syphilis during pregnancy. Pregnant women with syphilis in any stage who report penicillin allergy should be desensitized and treated with Benzathine penicillin G.
5. Due to the recent changes in health care delivery and a nationwide shortage of the drug, some providers have not been able to obtain cost-effective access to Benzathine penicillin G for their at-risk pregnant clients.  In these situations, providers are strongly encouraged to contact PADOH for treatment assistance.
6. For children or congenital syphilis, see Sexually Transmitted Infections Treatment Guidelines, 2021 at: www.cdc.gov/std/treatment
   

STD Reporting

PA-NEDSS – PA-NEDSS is the mandatory method for providers and laboratories to report diseases and investigate findings to the Pennsylvania Department of Health (DOH).
For general information about PA-NEDSS or registering new users, please send an email to NEDSS@pa.gov.
For technical issues with PA-NEDSS please send an email to NEDSS_Technical@pa.gov.
Telephone: 717-783-9171
Pennsylvania Disease Reporting Mandates
PADOH Instructional Video on How to Report New Cases of STDs and Related Treatment

Management of Sex Partners

Effective clinical management of patients with treatable STIs requires treatment of the patient's recent sex partners to prevent reinfection and curtail further transmission.

Patients should be instructed to refer their sex partners for evaluation and treatment.

1. Persons who have had sexual contact with a person who receives a diagnosis of primary, secondary, or early latent syphilis <90 days before the diagnosis should be treated presumptively for early syphilis, even if serologic test results are negative or unknown.
2. Persons who have had sexual contact with a person who receives a diagnosis of primary, secondary, or early latent syphilis >90 days before the diagnosis should be treated presumptively for early syphilis if serologic test results are not immediately available and the opportunity for follow-up is uncertain. If serologic tests are negative, no treatment is needed. If serologic tests are positive, treatment should be based on clinical and serologic evaluation and syphilis stage.
3. Long-term sex partners of persons who have late latent syphilis should be evaluated clinically and serologically for syphilis and treated based on the findings
   

Additional Information

Physicians needing additional information are asked to call the following number:
Pennsylvania Department of Health
Bureau of Communicable Diseases
Division of TB/STD
STD Program
(717) 787-3981
8:00 A.M. – 5:00 P.M
 

Additional Web Links

Additional information on syphilis testing and treatment for pregnant women can be found online at: www.cdc.gov/std/treatment

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