title: Adverse pregnancy outcomes following syphilis treatment in pregnancy in the UK.
abstract: Syphilis infection in pregnancy is known to cause a number of severe adverse pregnancy outcomes, including second-trimester miscarriage, stillbirth, very pre-term delivery and neonatal death, in addition to congenital syphilis. A retrospective review of women with positive syphilis serology and a pregnancy outcome between 2005 and 2012 in Leeds, UK, was performed. In all, 57 cases of positive syphilis serology in pregnancy were identified: 24 with untreated syphilis treated in the current pregnancy (Group 1); seven with reported but unconfirmed prior treatment who were retreated (Group 2); and 26 adequately treated prior to pregnancy (Group 3). The rate of severe adverse pregnancy outcomes in Group 1 at 21% was significantly higher than the 0% outcome of Group 3 (p = 0.02). The severe adverse pregnancy outcomes were two second-trimester miscarriages, two pre-term births at 25 and 28 weeks and one stillbirth at 32 weeks. There were no cases of term congenital syphilis or term neonatal death, but we observed high rates of other adverse pregnancy outcomes despite treatment during pregnancy. Rapid referral for treatment is needed before 18 weeks in order to minimise adverse pregnancy outcomes.
authors.affiliation: Department of Genitourinary Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: Harriet E
authors.initials: HE
authors.lastname: Wallace
authors.affiliation: University of Leeds Medical School, Leeds, UK.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Isitt
authors.affiliation: University of Leeds Medical School, Leeds, UK.
authors.forename: Harriet M
authors.initials: HM
authors.lastname: Broomhall
authors.affiliation: Department of Obstetrics, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: Alison E
authors.initials: AE
authors.lastname: Perry
authors.affiliation: Department of Genitourinary Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK janet-d.wilson@nhs.net.
authors.forename: Janet D
authors.initials: JD
authors.lastname: Wilson
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D010406:Penicillins / Q000627:therapeutic use; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D013587:Syphilis / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D013588:Syphilis Serodiagnosis; D014210:Treponema pallidum / Q000276:immunology / Q000302:isolation & purification*; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D010406:Penicillins
keywords: Syphilis; Treponema pallidum; adverse pregnancy outcomes; congenital syphilis; pregnancy; women