••• Chapter 14^ Management of Medical and Surgical Conditions in Pregnancy^143
❍ What are the stages of syphilis?
Primary: Painless chancre
Secondary: Disseminated disease with macular rash and condylomata lata, fever, myalgias, and malaise
Latent: Untreated primary or secondary syphilis that has no clinical manifestations but may be diagnosed by
serologic testing
Tertiary: Characterized by gummas, neurosyphilis, or cardiovascular syphilis
❍ What is the treatment of syphilis and what reaction may occur when treatment is given to pregnant women?
Penicillin G is the only proven effective treatment of syphilis. Women with anaphylaxis to penicillin should be
desensitized. Women treated for syphilis in pregnancy may develop a Jarisch-Herxheimer reaction involving uterine
contractions and late fetal heart rate decelerations. These resolve within 24 hours.
❍ To which HIV-infected pregnant woman should antiretroviral treatment be offered?
All HIV-infected women regardless of T cell count or viral load.
❍ How should HIV RNA levels be monitored?
Four weeks after initiation of a change in treatment, monthly until undetectable, then every 3 months including a
value near term.
❍ What is the regimen of zidovudine antepartum?
100 mg orally five times daily, 200 mg three times daily, or 300 mg twice daily.
❍ When should IV zidovudine be started prior to elective cesarean delivery?
3 hours prior to surgery.
❍ What is the maternal treatment if the HIV RNA level is >1000 copies/mL?
Combination antiretroviral therapy.
❍ What is the recommended mode of delivery?
Scheduled cesarean delivery as early as 38 weeks is recommended for HIV-infected women with over 1000 copies/mL
of HIV RNA. Cesarean delivery is unlikely to offer additional benefit when the HIV RNA levels are below
1000 copies/mL.
❍ Who should be screened for gonorrhea and what is the treatment of a positive result?
All women should be screened for Gonorrhea and Chlamydia at the first prenatal visit. Treatment of gonorrhea in
pregnancy is ceftriaxone 250 mg IM and 1 g of azithromycin orally due to increasing prevalence of ceftriaxone
resistant gonorrhea. A test of cure should be conducted 1 week after treatment.
❍ When should women with bacterial vaginosis be treated?
Symptomatic women should be treated with metronidazole, 500 mg bid for 7 days. Vaginal metronidazole or
clindamycin may also be used. Treatment does not decrease the rate of preterm birth.