Medical director of Perinatal Infectious Diseases, Parkland Hospital, and assistant professor of Obstetrics and Gynecology in the division of Maternal-Fetal Medicine at the University of Texas Southwestern Medical Center in Dallas.

Emily Adhikari, MD

As with other vaccine trials, pregnant women were not included in the trials for the two vaccines that have been approved for COVID-19.

“I suspect follow-up studies will involve the surveillance of side effects from the 

 program as well as other studies (including our own group) who look to evaluate pregnancies in women who received the vaccine,” she said. 

“I suspect there will not be large clinical trials now that the vaccines are made available to pregnant women but there will be follow-up studies of antibody titers, etc., in pregnancy/lactation following vaccination. (It) might be hard to do a placebo-controlled trial at this point.”

As the United States rolls out its program to vaccinate the population, myths persist for the safety and efficacy of the vaccine for pregnant and lactating women, including the notion that the vaccine can cause infertility or the belief that Bell’s palsy can be a side effect. 

, which also will appear in the February print issue of 

She elaborates on the points included in that FAQ in this video interview.

The American College of Obstetricians and Gynecologists (ACOG) last updated its practice advisory on Dec. 21 for “Vaccinating Pregnant and Lactating Patients Against COVID-19,” the link for which can be found 

. In that advisory, ACOG recommended that vaccines not be withheld from pregnant individuals who meet the criteria for vaccination based on the priority groups established by the Advisory Committee on Immunization Practices (ACIP).

Videos

In this video, Senior Editor Angie DeRosa interviews Emily Adhikari, MD, on questions or concerns she and colleagues are hearing from patients surrounding the COVID-19 vaccine. 

COVID-19 Vaccine: Questions and answers for practicing ob/gyns and their patients

Currently, the two available vaccines for coronavirus disease 2019 are messenger RNA (mRNA) vaccines. This type of vaccine teaches cells how to make a protein, starting an immune response that creates antibodies. The antibodies protect us from getting infected when exposed to COVID-19.

The COVID-19 vaccine is different than influenza, or other vaccines, that rely on either live or inactivated virus to create the immune response.

There are two vaccines approved by the FDA. Both were tested to prevent COVID-19 disease.

There is no evidence suggesting risk from mRNA vaccines in pregnant or lactating women, but long-term safety and efficacy studies have not yet been published. That said, there is no biologically plausible evidence to suggest that harm to a pregnant woman or her fetus is possible from these vaccines. The currently available COVID-19 vaccines contain a piece of mRNA delivered within a lipid capsule. This capsule fuses with the cell membrane to deliver the mRNA. This mRNA sends a message to the cell to trigger the immune response and then is quickly degraded, never entering the nucleus or changing DNA in any way.

According to the American College of Obstetricians and Gynecologists (ACOG), the COVID-19 vaccine should not be withheld from pregnant women who meet criteria for vaccination

The vaccine also should be offered to lactating women.

 There is potential for a vaccinated mother to make protective antibodies that are passed to her infant based on experience with other vaccines in pregnancy (such as influenza vaccines), although this has not been completely studied yet for the COVID-19 vaccine.

The recommended considerations for vaccinating a pregnant woman against COVID-19 include the level of community transmission, her personal risks, and anticipated side effects, which are thought to be similar to other vaccines.

If a fever develops, pregnant women may take acetaminophen.

There is no need for a pregnancy test before vaccination.

Once vaccinated, do I need to wear a mask? 

Although the vaccines are highly protective, neither Pfizer nor Moderna vaccines provide 100% efficacy. We need more information to tell whether a vaccinated person can become infected without symptoms, or still pass the virus to others. This is being studied but it means we still have to wear masks after vaccination.

Can I get another vaccine at the same time as the COVID vaccine?

The recommendation is to administer the COVID-19 vaccine alone, with minimal interval of 14 days from other vaccines. If accidentally done, neither vaccine should be re-administered.

What if I miss the window for the second dose?

For either vaccine, if you miss the recommended timeframe for the second dose you should get it at the earliest opportunity. You do not need to restart the series.

No, the two vaccines (Pfizer vs Moderna) are not interchangeable. If inadvertently done, no additional doses should be administered until more is known.

Yes, these vaccines are safe, and they stimulate our body to make antibodies so our cells can fight off the SARS-CoV-2 virus that causes COVID-19 disease. The technology used to create them is not new, and is based on sequencing technology that has been around for years, but has not yet been used as part of a coordinated global effort to address a public health crisis such as this. 

Older vaccines like influenza require large amounts of live virus to be grown in special labs. This takes time and for COVID-19 would require extreme safety measures. 

The mRNA vaccines are not live virus, and are developed based on the sequence of the virus that is known. This makes vaccine development much faster, but still very accurate, and safe.

If I had COVID or was exposed to the virus, should I still get the vaccine?

Yes, even those who had COVID-19 should be vaccinated once they are recovered. We do not yet know how long the immune response to natural infection lasts, and the vaccine has been shown to be effective in preventing infection. 

If you are acutely infected, you should wait until you have recovered to receive the vaccine. 

If you are recently exposed or in quarantine, you should wait until the end of quarantine to avoid exposure to health care workers. 

If I had COVID or was exposed, do I need to get blood work done to look for antibodies before getting the vaccine?

No, there is no need to evaluate for antibodies before vaccination. 

If I have medical conditions, like diabetes or high blood pressure, should I get the vaccine? 

Yes! These medical conditions may result in a more severe infection with COVID-19 so it is important to get vaccinated.

If I am immunocompromised should I get the vaccine?

There is limited data available, but vaccination may provide key protection against the virus in those with suppressed immune systems. The COVID-19 vaccines do not contain live virus.

Does either COVID-19 vaccine cause infertility?

Despite social media chatter, antibodies to the spike protein have not been linked to infertility after COVID-19 infection, and there is no scientific reason to believe this will change after vaccination for COVID-19. 

No other viral infection or vaccination-inducing immunity by similar mechanisms has been shown to cause infertility. 

Women should feel comfortable that this claim has no basis in science.

Does the COVID-19 vaccine cause Bell’s palsy?

This question comes from the side effects reported in the Moderna vaccine trial, which included 30,400 participants. 

Companies track every complaint, regardless of whether linked to vaccination. In the trial,

 participants reported Bell’s palsy symptoms: 3 in the vaccine and 1 in the placebo group. This was not a significant difference and thus was not attributed to the COVID-19 vaccine.

Will the vaccine cause male pattern hair growth?

No, there is no evidence the vaccine causes women to grow beards or mustaches. 

In contrast, COVID-19 illness has been linked to 

Thus, vaccination will not increase undesired hair growth and may prevent undesired hair loss from COVID-19.

How does the vaccination affect testing for COVID-19 disease?

Vaccination will not affect results of nasal, nasopharyngeal, or saliva PCR or rapid antigen tests for diagnosis of acute infection. 

Currently, the antibody tests available in laboratories check for IgM or IgG to either spike or nucleocapsid proteins. 

Positive antibody (IgG) to spike protein could mean evidence of prior infection or vaccination. 

To document prior natural infection with live virus, laboratory evidence of antibody to nucleocapsid protein is needed.

How do I know if symptoms after vaccination are due to the vaccine or COVID-19 infection?

Signs and symptoms unlikely to be from COVID-19 vaccination include: Cough, shortness of breath, rhinorrhea, sore throat, loss of taste or smell; 

Signs and symptoms that may be from either COVID-19 vaccination, SARS-CoV-2 infection,or another infection include: Fever, fatigue, headache, chills, myalgia, and/or arthralgia.

People who have had anaphylaxis or severe allergic reaction to any component of the vaccine.

1. Polack FP, Thomas SJ, Kitchin N, et al. C4591001 Clinical Trial Group. Safety and Efficacy of the BNT162b2 mRNA COVID-19 Vaccine. N Engl J Med. Published online Dec 10, 2020: NEJMoa2034577. doi:10.1056/ NEJMoa2034577. PMID: 33301246; PMCID: PMC7745181.

2. The United States Food and Drug Administration. Vaccines and Related Biological Products Advisory Committee Meeting, Dec. 17, 2020. Accessed Dec. 21, 2020. https://www.fda.gov/media/144434/download

3. The American College of Obstetricians and Gynecologists. Vaccinating Pregnant and Lactating Patients Against COVID-19. Accessed online Dec. 21, 2020.

https://www.acog.org/en/clinical/clinical-guidance/practice-advisory/articles/2020/12/vaccinating-Pregnant-and-Lactating-Patients-Against-COVID-19

4. Oliver SE, Gargano JW, Marin M, et al. The Advisory Committee on Immunization Practices’ Interim Recommendation for Use of Pfizer-BioNTech COVID-19 Vaccine - United States, December 2020. MMWR

Morb Mortal Wkly Rep. Dec. 18, 2020;69(50):1922-1924. doi:10.15585/mmwr.mm6950e2. PMID: 33332292.

5. Wambier CG, Vaño-Galván S, McCoy J, et al. Androgenetic alopecia present in the majority of patients hospitalized with COVID-19: The “Gabrin sign”. J Am Acad Dermatol. August 2020;83(2):680-682. doi:10.1016/j.jaad.2020.05.079. Epub May 22, 2020. PMID: 32446821; PMCID: PMC7242206.

Articles

This FAQ is a printable reference for ob/gyns. It features information on the COVID-19 vaccines, as well as frequently asked questions and answers for ob/gyns to use when counseling patients. 

Frequently Asked Questions: COVID-19 vaccines

Syphilis, known as the “the great imitator,” is a clinical disease with myriad manifestations and stages. Clinical illness results from infection with the spirochete 

which enters at sites of sexual contact and by transmission across the placenta during pregnancy. 

Maternal syphilis is associated with a 21% increased risk for stillbirth, 6% increased risk for preterm delivery, and 9% increased risk for neonatal death.

 Between 2014 and 2018, primary and secondary syphilis in women increased by 172% (to 3 cases per 100,000 females) in the United States.

Congenital syphilis rates have paralleled this rise, increasing by 185% (to 33.1 cases per 100,000 live births) in the same years. Experts believe that recent upward trends are multifactorial,

and the coronavirus disease 2019 pandemic certainly has disrupted ongoing efforts at reversing these trends, with closure of sexual health clinics and redirected public health efforts from a focus on sexually transmitted diseases to mitigating the COVID-19 crisis.

As the pandemic rages on, we have yet to see how long-term effects of this generation-defining crisis will later manifest as “second waves” of other, neglected diseases such as syphilis. To prepare clinicians for what lies ahead, we review the diagnosis and management of syphilis in pregnancy.

All pregnant women should be screened for syphilis at the first prenatal visit or at first presentation to care.

 Screening and treatment early in pregnancy is associated with decreased incidence of congenital syphilis, preterm birth, low birth weight, stillbirth, and neonatal death.

Repeat screening in the early third trimester, between 28 and 32 weeks of gestation, and again at delivery is recommended in women at high risk for syphilis or who live in areas with high syphilis prevalence.

 State laws differ with regard to required timing and frequency of testing, and clinicians should familiarize themselves with current state prenatal screening and reporting requirements. In some states, providers who fail to abide by syphilis screening laws may be subject to civil or criminal liabilities.

 Testing for maternal syphilis is recommended as part of the evaluation for stillbirth.

 HIV and other STI screening should be offered when syphilis is diagnosed.

Although some syphilis infections may come to the attention of providers after a patient reports symptoms or lesions, the most common pathway is for clinicians to make a laboratory diagnosis first, which must be followed by patient counseling 

 thorough history and physical (including pelvic) examination to complete a clinical staging evaluation. 

Following all three of these elements (laboratory studies, thorough sexual history, and physical with pelvic examination), the clinical stage of syphilis is determined, any necessary fetal evaluation completed, and a treatment regimen may be prescribed. 

Confusion commonly arises when abnormal laboratory evaluation is detected at an initial visit prior to complete history and physical examination – 

just because the patient’s laboratory values are abnormal for the first time does not mean that the patient has a diagnosis of primary syphilis.

Not all patients experience all symptomatic stages of syphilis, and unless physical signs of primary or secondary syphilis are clearly documented and supported by clinical history and laboratory studies, the assumption of recent infection should not be made.

Primary syphilis, which occurs around 3 weeks after initial infection by the spirochete through any site of sexual contact, is characterized by a painless chancre (

Because the site of the chancre may be located on the cervix or vagina, lesions may be missed without a thorough pelvic examination. Women with immunosuppression may experience multiple chancres or chancres that persist after secondary lesions appear.

 The chancre resolves within 4 to 6 weeks even without treatment (sooner if treated), although inadequate immune-mediated clearance results in systemic dissemination of organisms and later secondary manifestations of disease around 6 to 8 weeks later. 

Classic symptoms of secondary syphilis are diffuse maculopapular skin rash (in up to 90%), generalized lymphadenopathy, and highly-contagious mucosal lesions including oral mucous patches

 and genital condyloma lata. Some women may describe systemic symptoms such as malaise, arthralgias, and fevers. Manifestations of secondary syphilis resolve after approximately 1 to 6 months regardless of treatment and typically resolve within a few weeks after adequate syphilotherapy.

Latent syphilis is characterized by positive diagnostic testing in a patient without objective findings. Clinically, latent syphilis is divided into early and late (or unknown duration) latent stages, depending on the timing of initial infection based on a detailed history of exposure and reported symptoms. 

In 2018, the Centers for Disease Control and Prevention (CDC) began using the surveillance term “syphilis, early non-primary non-secondary” rather than “early latent syphilis” to clarify that some clinical manifestations such as neurosyphilis may occur during any stage.

 From a clinical perspective, however, either name represents 

 infection, which is clearly documented based on laboratory seroconversion to have occurred within the previous 12 months

In a woman with early latent syphilis, secondary lesions may recur in 25% of patients. In late latent syphilis, now known as “unknown duration or late syphilis” from a surveillance perspective, infection duration is either unknown or greater than one year. Late latent syphilis is relatively less contagious to sexual partners but still transmissible to the fetus in pregnancy, with an approximate 10% risk of fetal infection.

Tertiary syphilis, which occurs in up to 40% of individuals with untreated syphilis, refers to benign gummas and cardiovascular syphilis, but not to neurosyphilis. It is rare in a reproductive-aged population.

Neurosyphilis is clinically described as 

 neurosyphilis, as manifestations may occur at any time during the course of infection. Early neurologic involvement may include meningitis, uveitis or retinitis, or stroke-like symptoms, and occurs in approximately 1% of patients with secondary syphilis.

 Late neurosyphilis occurs a decade or more after initial diagnosis, and may occur along with other manifestations of tertiary syphilis.

Congenital syphilis may result from maternal syphilis infection prior to or during pregnancy, or when maternal syphilis is diagnosed at delivery.

Diagnosis of congenital syphilis following delivery is challenging, and involves assessment of maternal history and laboratory studies, complete physical, laboratory and radiologic evaluation of a neonate, and may include pathologic evaluation of the placenta. 

Risk of congenital infection is related to the stage of maternal infection, and occurs in approximately 50-80% of women with untreated primary, secondary, or early latent syphilis, and up to 10% of women with late latent syphilis. Syphilitic stillbirths also are included as cases of congenital syphilis for national reporting purposes.

Neonatal manifestations of congenital syphilis are divided into two characteristic syndromes. 

 is diagnosed in the first two years of life, and may involve clinical symptoms similar to those in adult secondary syphilis. 

Classically, hepatosplenomegaly, desquamating skin rash, rhinitis (“snuffles”), anemia, thrombocytopenia, and osteochondritis may be observed.

 manifests after two years of life, and may be characterized by notched teeth (Hutchinson’s teeth), deafness, and interstitial keratitis of the eye; together, these are known as 

. Central nervous system involvement with developmental delay, hydrocephalus, seizures, and nerve palsies, as well as bone deformities, may occur.

At delivery, the placenta itself may have gross and histopathologic characteristics of 

 infection. On gross examination, the placenta appears large, pale, and hydropic. 

On microscopic examination, terminal villi appear enlarged and densely cellular, with evidence of chronic villitis.

 Umbilical cord sections demonstrate necrotizing funisitis, characterized by perivascular rings of necrotic debris surrounding the large vessels. 

These findings are not specific to syphilis infection, however. In some laboratories, 

 may be directly detected by immunohistochemistry in either placenta or umbilical cord specimens in a woman with untreated or inadequately treated syphilis. This evaluation should be encouraged when feasible, as the direct detection of 

facilitates accurate reporting and optimal maternal and neonatal care.

 is difficult to visualize or directly detect with common methods available in most laboratories (such as culture or polymerase chain reaction [PCR]). Clinicians usually rely on serologic testing, which allows only indirect diagnosis of infection, and must be combined with complete history and physical (with pelvic) examination. 

Two algorithms are used, and require slightly different interpretation (

In a traditional screening algorithm, presumptive serologic diagnosis of syphilis requires two tests: an initial nontreponemal test followed by a confirmatory treponemal-specific test.

 The rapid plasma reagin is the most commonly used nontreponemal antibody in the United States. This test measures antibody to cardiolipin, which is thought to be contained within 

 as well as in the damaged host cell membrane.

 A confirmatory test is required because false-positive nontreponemal tests occur, and the false-positive rate for a rapid plasma reagin is about 1% in pregnant women.

 When reactive, the nontreponemal test is quantified as a titer, which typically correlates with disease activity and is used to follow treatment response.

The reverse sequence algorithm begins with a treponemal antibody test, typically an automated enzyme or chemiluminescent immunoassays (EIA or CIA). 

The advantage to this test is in the laboratory through-put: for high volume laboratories, the ability to perform automated testing has proposed cost advantages.

 The sensitivity of available treponemal immunoassays ranges between 97% and 100%, depending on clinical stage and the specific assay used.

However, false-positive rates are as high as 40 to 80%, and thus reflex testing is still required.

 When reactive, a treponemal immunoassay is reflexed to a nontreponemal test, which then (if reactive) must be interpreted as presumptive active syphilis or (if nonreactive) reflexed to a second treponemal test (typically 

With either algorithm, a detailed clinical history and physical exam are needed to establish risk factors for syphilis, confirm previous treatment regimens, and document any physical evidence of early-stage infection. If no previous treatment can be confirmed in an asymptomatic patient with laboratory evidence of syphilis, initiation of a full course of treatment for latent syphilis is recommended following consultation with a specialist and fetal evaluation, if indicated.

Congenital infection is presumed in all cases of maternal syphilis infection during pregnancy. When present, sonographic findings consistent with congenital infection represent severely infected fetuses. 

Ultrasound findings of congenital infection typically are not manifest until after approximately 18 to 20 weeks of gestation due to relative immaturity of the fetal immune response. Findings may include placentomegaly (thickness exceeding 4cm), hepatomegaly, polyhydramnios, ascites, and non-immune hydrops.

Detailed sonography is indicated with performance of middle cerebral artery Doppler studies to evaluate for fetal anemia when maternal syphilis is diagnosed.

 When ultrasound findings of congenital syphilis are identified after fetal viability, initial treatment in an inpatient setting with monitoring of the mother and fetus are recommended to detect possible fetal distress or preterm labor.

Optimal treatment of syphilis during pregnancy is estimated to reduce the risk of congenital syphilis by 97%, stillbirth by 82%, preterm birth by 64%, and neonatal mortality by 80%.

Long-acting parenteral penicillin G is the only currently recommended treatment for syphilis in pregnancy.

 For early-stage syphilis, including primary, secondary, and early latent (early non-primary non-secondary), a single intramuscular dose of 2.4 million units of benzathine penicillin G is necessary. 

Some experts recommend two weekly doses of 2.4 million units of benzathine penicillin G for women diagnosed with early clinical stage infection, because congenital syphilis may still occur despite treatment with a single dose, particularly with high nontreponemal titers common to early maternal stage syphilis.

 Our practice is to routinely administer two doses of 2.4 million units intramuscular benzathine penicillin G over 2 consecutive weeks to all women with early-stage syphilis, with an interval of no more than 10 days between injections.

Have you been witnessing a rise in syphilis cases among your patients? How do you think increasing telehealth appointments could benefit your patients? 

Let us know what you think by sending an email to COGeditorial@mmhgroup.com or via Twitter @ContempOBGYN.

Treatment with three weekly doses of 2.4 million units intramuscular benzathine penicillin G is necessary for late latent (unknown duration or late syphilis) in pregnancy. Currently the CDC acknowledges that an interval of 7-9 days between doses may be optimal based on pharmacokinetic studies, but clinical experience suggests that an interval of 10-14 days between doses may be acceptable.

 A conservative practice is to allow an interval of up to 10 days between intramuscular injections for treatment of late latent syphilis in pregnancy. If a patient misses a scheduled dose, the treatment course is restarted.

For pregnant women reporting a penicillin allergy, a thorough clinical history should be taken to determine whether the reported reaction is 

 for anaphylaxis or other life-threatening drug reaction.

 In women with a clinical history consistent with a moderate to high-risk allergic reaction, formal evaluation for possible penicillin allergy testing in a setting with clinicians trained in recognition and treatment of hypersensitivity reactions is recommended. 

For women with verified IgE-mediated hypersensitivity reactions, penicillin desensitization is indicated.

 Fortunately, this is rarely necessary. Importantly, in women with IgE-mediated allergy who undergo desensitization and treatment with penicillin and are later reinfected, repeat allergy testing and desensitization is necessary because IgE antibodies may reform.

Symptoms of primary or secondary syphilis should resolve within a few weeks after treatment is initiated. In the first 24 hours following initial treatment, some women may experience a Jarisch-Herxheimer reaction, an acute febrile reaction characterized by myalgia, fever, headache, and potentially preterm labor and fetal heart rate tracing abnormalities in pregnant women. 

Before treatment, women should be counseled about the potential for these symptoms, as well as on appropriate management with antipyretics. Because fetal heart rate tracing abnormalities may occur in a severely affected fetus, initial treatment at a center with the capability for emergent delivery and neonatal stabilization is recommended for women with ultrasound evidence of congenital infection in a potentially viable fetus. Subsequent doses are administered in the outpatient setting as appropriate for the clinical stage of infection. 

In general, a nontreponemal titer may be repeated if maternal re-exposure to an untreated partner is suspected, although the decision to retreat is a clinical one. There is little evidence supporting the benefit of repeating monthly nontreponemal titers following adequate therapy. 

In all women, we inquire about partner treatment and potential for re-exposure at each prenatal visit after maternal diagnosis, and repeat a rapid plasma reagin test at 28-32 weeks or sooner if the clinical history suggests re-exposure or reinfection. If clinical symptoms persist or recur, or when nontreponemal titer increases by fourfold (2-dilution) or greater for more than 2 weeks, reinfection should be considered and retreatment initiated.

Some patients may have a persistent low nontreponemal titer known as “serofast” despite complete treatment (typically <1:8). 

A serofast rapid plasma reagin is more common with lower initial rapid plasma reagin titers and latent syphilis at the time of diagnosis.

 When past treatment has been confirmed and there is no suspicion of re-exposure in a patient with serofast rapid plasma reagin or venereal disease research laboratory test, no additional treatment is indicated. 

A final nontreponemal titer is repeated at the time of delivery for all women diagnosed with syphilis during pregnancy, and for all women in some states. 

This confirms maternal treatment response (or lack thereof) and allows for a direct comparison of the neonatal nontreponemal titer, which may reflect maternal antibody levels or neonatal response to congenital infection.

Despite near elimination of syphilis in the United States only two decades ago, maternal and congenital syphilis have made an unwelcome return, even as we face new challenges with the COVID-19 pandemic. 

Ob/gyns should be well-informed about current guidelines for syphilis screening and management in pregnancy. Ultimately, 

 collaboration among physicians, scientists, public health facilities, and political leaders will be needed to increase public and physician awareness, facilitate access to early prenatal care in underserved communities, and reverse the current epidemic.

Gomez GB, Kamb ML, Newman LM, Mark J, Broutet N, Hawkes SJ. Untreated maternal syphilis and adverse outcomes of pregnancy: a systematic review and meta-analysis. Bulletin of the World Health Org 2013;91:217-26.

Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2018. Atlanta, U.S. Department of Health and Human Services, 2019.

Leichliter JS, Heyer K, Peterman TA, Habel MA, Brookmeyer KA, Arnold Pang SS, et al. US Public sexually transmitted disease clinical services in an era of declining public health funding: 2013-14. Sex Transm Dis 2017;44:505-9.

Impact of Cuts to Federal STD Prevention Funding. National Coalition of STD Directors, 2017. (Accessed October 30, 2019, at 

http://www.nmac.org/wp-content/uploads/2017/07/Impact-of-Proposed-Budget-Cuts-on-STDS.pdf

Kidd S, Bowen VB, Torrone EA, Bolan G. Use of national syphilis surveillance data to develop a congenital syphilis prevention cascade and estimate the number of potential congenital syphilis cases averted. Sex Transm Dis 2018;45:S23-s8.

Ollstein AM. CDC: Testing for STDs plummeted during pandemic. 

. September 14, 2020. Accessed Nov 4, 2020. 

American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Guidelines for perinatal care. 8th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2017.

Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2015.MMWR 2015 64(3):1-140.

U.S. Preventive Services Task Force. Screening for syphilis infection in pregnant women: U.S. Preventive Services Task Force reaffirmation recommendation statement. JAMA 2018;320:911-7.

Qin J, Yang T, Xiao S, Tan H, Feng T, Fu H. Reported estimates of adverse pregnancy outcomes among women with and without syphilis: a systematic review and meta-analysis. PLoS One 2014;9:e102203.

Matthias JM, Rahman MM, Newman DR, Peterman TA. Effectiveness of prenatal screening and treatment to prevent congenital syphilis, Louisiana and Florida, 2013-2014. Sex Transm Dis 2017;44:498-502.

Warren HP, Cramer R, Kidd S, Leichliter JS. State requirements for prenatal syphilis screening in the United States, 2016. Matern Child Health J 2018;22:1227-32.

Public Health Law Research, Temple University. State statutes explicitly related to sexually transmitted diseases in the United States, 2013. Available at

https://www.cdc.gov/std/program/final-std-statutesall-states-5june-2014.pdf

American College of Obstetricians and Gynecologists: Management of Stillbirth. Practice Bulletin No. 102, March 2009, Reaffirmed 2019.

Hutchinson CM, Hook EW, Shepherd M, Verley J, Rompalo AM. Altered clinical presentation of early syphilis in patients with human immunodeficiency virus infection. Ann Int Med 1994;121:94-100.

de Paulo LF, Servato JP, Oliveira MT, Durighetto AF, Jr., Zanetta-Barbosa D. Oral manifestations of secondary syphilis. Int J Infect Dis 2015;35:40-2.

Centers for Disease Control and Prevention. Syphilis (Treponema pallidum) 2018 Case Definition. 2018. Available at 

https://wwwn.cdc.gov/nndss/conditions/syphilis/case-definition/2018/

Lafond RE, Lukehart SA. Biological basis for syphilis. Clin Micro Rev 2006;19:29-49.25.

de Voux A, Kidd S, Torrone EA. Reported cases of neurosyphilis among early syphilis cases-United States, 2009 to 2015. Sex Transm Dis 2018;45:39-41.

Cooper JM, Sanchez PJ. Congenital syphilis. Sem Perinatology 2018;42:176-84.

Sheffield JS, Sanchez PJ, Wendel GD, Jr., Fong DW, Margraf LR, Zeray F, et al. Placental histopathology of congenital syphilis. Obstet Gynecol 2002;100:126-33.

Gao K, Shen X, Lin Y, Tong ML, Xiao Y, Zhang HL, et al. Origin of nontreponemal antibodies during 

 infection: evidence from a rabbit model. J Infect Dis 2018;218:835-43.

Peter CR, Thompson MA, Wilson DL. False-positive reactions in the rapid plasma reagin-card, fluorescent treponemal antibody-absorbed, and hemagglutination treponemal syphilis serology tests. J Clin Micro 1979;9:369-72.

Buono SA, Basurto-Davila R, Godwin HA, Green NM. Economic assessment of reverse algorithm syphilis screening in a high prevalence population. Sex Transm Dis 2018;45:834-41.

, et al. Performance of Treponemal Tests for the Diagnosis of Syphilis. 

Adhikari EH, Frame IJ, Hill E, et al. Abbott ARCHITECT Syphilis TP Chemiluminescent Immunoassay Accurately Diagnoses Past or Current Syphilis in Pregnancy. Am J Perinatol 2020;37:112-8.

Lin JS, Eder ML, Bean SI. Screening for syphilis infection in pregnant women: updated evidence report and systematic review for the U.S. Preventive Services Task Force. JAMA 2018;320:918-25.

Hollier LM, Harstad TW, Sanchez PJ, Twickler DM, Wendel GD, Jr. Fetal syphilis: clinical and laboratory characteristics. Obstet Gynecol 2001;97:947-53.

Society for Maternal-Fetal Medicine, Norton ME, Chauhan SP, Dashe JS. Clinical Guideline #7: Nonimmune hydrops fetalis. Am J Obstet Gynecol 2015;212:127-39..

. Lives Saved Tool supplement detection and treatment of syphilis in pregnancy to reduce syphilis related stillbirths and neonatal mortality. 

Diagnosis and treatment of “the great imitator” that has resurged.

Emily Adhikari, MD

Articles

COVID-19 Vaccine: Questions and answers for practicing ob/gyns and their patients

Frequently Asked Questions: COVID-19 vaccines

Syphilis in pregnancy