Syphilis management in pregnancy: a review of guideline recommendations from countries around the world
Open accessAbstract
Guidelines can help healthcare practitioners manage syphilis in pregnancy and prevent perinatal death or disability. We conducted systematic reviews to locate guidance documents describing management of syphilis in pregnancy, 2003-2017. We compared country and regional guidelines with current World Health Organization (WHO) guidelines. We found 64 guidelines with recommendations on management of syphilis in pregnancy representing 128 of the 195 WHO member countries, including the two WHO guidelines published in 2016 and 2017. Of the 62 guidelines, 16 were for countries in Africa, 21 for the Americas, two for Eastern Mediterranean, six for Europe and 17 for Asia or the Pacific. Fifty-seven (92%) guidelines recommended universal syphilis screening in pregnancy, of which 46 (81%) recommended testing at the first antenatal care visit. Also, 46 (81%) recommended repeat testing including 21 guidelines recommended this during the third pregnancy trimester and/or at delivery. Fifty-nine (95%) guidelines recommended benzathine penicillin G (BPG) as the first-line therapy for syphilis in pregnancy, consistent with WHO guidelines. Alternative regimens to BPG were listed in 42 (68%) guidelines, primarily from Africa and Asia; only 20 specified that non-penicillin regimens are not proven-effective in treating the fetus. We identified guidance recommending use of injectable penicillin in exposed infants for 112 countries. Most guidelines recommended universal syphilis testing for pregnant women, repeat testing for high-risk women and treatment of infected women with BPG; but several did not. Updating guidance on syphilis testing and treatment in pregnancy to reflect global norms could prevent congenital syphilis and save newborn lives.
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La OMS recomienda la realización de la prueba de sífilis para todas las mujeres embarazadas en la primera visita de atención prenatal y como tratamiento de primera línea se aconseja el uso de la penicilina G.
“En estas se recomienda la realización de la prueba de sífilis para todas las mujeres embarazadas en la primera visita de atención prenatal y como tratamiento de primera línea se aconseja el uso de la penicilina G.”
From Syphilis and pregnancy. Treatment Guidelines (2022) · cites this paper as [5]
According to WHO guidelines, the recommended first-line treatment is penicillin G benzathine at a dosage of 2.4 million units.
“According to WHO guidelines, the recommended firstline treatment is penicillin G benzathine at a dosage of 2.4 million units.7,8”
From Fetal Outcome in Pregnancy Infected Syphilis Treated with Penicillin G: A Systematic Review: Analysis (2025) · cites this paper as [7]
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- Authors
- Trinh, T., Leal, A. F., Mello, M. B., Taylor, M. M., Barrow, R., Wi, T. E., & Kamb, M. L.
- Affiliations
- Centers for Disease Control and Prevention (US)
- World Health Organization Regional Office for the Americas (US)
- World Health Organization (CH)
- Center for Global Health (US)
- Corresponding author
- Trinh, Thuy
- Venue
- Sexual and Reproductive Health Matters
- Publisher
- Informa UK Limited
- Published
- 2019-01-01
- Volume
- 27
- Issue
- 1
- Pages
- 69-82
- ISSN
- 2641-0397 (ISSN-L)
- PMC
- PMC7888020
- OpenAlex
- W2998443470
- Cited by
- 46
- References
- 20
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 8 · 2023: 8 · 2022: 10 · 2021: 10
- FWCI
- 0.59
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Sexual and Reproductive Health Matters (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- World Health Organization
- Topics
- Health Sciences › Medicine › Physiology › Syphilis Diagnosis and Treatment
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Historical Medical Research and Treatments
- Keywords
- maternal syphilis, congenital syphilis, prenatal screening, benzathine penicillin G, treatment guidelines, guideline recommendations, penicillin therapy, infant prophylaxis, WHO guidelines
- MeSH terms
- Anti-Bacterial Agents, Female, Humans, Infant, Infant Mortality, Pregnancy, Pregnancy Complications, Infectious, Syphilis, Syphilis, Congenital, Global Health, World Health Organization, Guidelines as Topic
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