Syphilis in Pregnancy: Pharmacological and Therapeutic Challenges

Abstract:

Syphilis is a chronic, multistage sexually transmitted disease caused by the spirochete Treponema pallidum. Infection during pregnancy can lead to transplacental spread (congenital syphilis) and may be associated with adverse foetal outcomes, such as early foetal loss (miscarriages), stillbirths, neonatal deaths, low-birth-weight infants, and other sequalae of infection if left untreated or incompletely treated. Rising rates of congenital syphilis emulate general increases in the rate of primary and secondary syphilis among females and remains a global health concern, particularly in lower middle-income countries (LMIC). Treatment with benzathine penicillin G remains the treatment of choice in the absence of alternative suitable antimicrobials. However, in the past few years, treatment with penicillin has been affected by poor availability due to manufacturing challenges, supply chain issues and stock-outs in some settings. In this article, we highlight the pharmacological and therapeutic challenges during pregnancy, and reflect on challenges associated with alternative antimicrobial therapy.