Guideline

WHO guideline on syphilis screening and treatment for pregnant women

Year of Publication

2017

Issuing Institution

WHO

Links

WHO IRIS,Google Scholar

Recommendations

8 included recommendations

The WHO STI guideline recommends screening all pregnant women for syphilis during the first antenatal care visit

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

In settings with low coverage of syphilis screening and treatment for pregnant women, high loss to follow-up of pregnant women, or limited laboratory capacity, the WHO STI guideline suggests on-site tests (Strategies A, B and C) rather than the standard off-site laboratory based screening and treatment strategy

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

In settings with a low prevalence of syphilis (below 5%), the WHO STI guideline suggests a single on-site rapid syphilis test (RST) be used to screen pregnant women (Strategy A) rather than a single on-site rapid plasma reagin (RPR) test (Strategy B).+++

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

In settings with a high prevalence of syphilis (5% or greater), the WHO STI guideline suggests an on-site rapid syphilis test (RST) and, if positive, provision of a first dose of treatment and a rapid plasma reagin (RPR) test, and then, if the RPR test is positive, provision of treatment according to duration of syphilis (Strategy C). The WHO STI guideline suggests this sequence of tests and treatment rather than a single on-site RST (Strategy A) or a single on-site RPR test (Strategy B).

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

In pregnant women with early syphilis, the WHO STI guideline recommends benzathine penicillin G 2.4 million units once intramuscularly over no treatment.

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Very low

In pregnant women with early syphilis, the WHO STI guideline suggests using benzathine penicillin G 2.4 million units once intramuscularly over procaine penicillin 1.2 million units intramuscularly once daily for 10 days. When benzathine or procaine penicillin cannot be used (e.g. due to penicillin allergy where penicillin desensitization is not possible) or are not available (e.g. due to stockouts), the WHO STI guideline suggests using, with caution, erythromycin 500 mg orally four times daily for 14 days or ceftriaxone 1 g intramuscularly once daily for 10–14 days or azithromycin 2 g once orally

Status

Retired

Recommended in favor

Conditional

Certainty of evidence

Very low

In pregnant women with late syphilis (more than two years’ duration) or unknown stage of syphilis, the WHO STI guideline recommends benzathine penicillin G 2.4 million units intramuscularly once weekly for three consecutive weeks over no treatment

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Very low

In pregnant women with late syphilis (more than two years’ duration) or unknown stage of syphilis, the WHO STI guideline suggests benzathine penicillin G 2.4 million units intramuscularly once weekly for three consecutive weeks over procaine penicillin 1.2 million units intramuscularly once a day for 20 days. When benzathine or procaine penicillin cannot be used (e.g. due to penicillin allergy where penicillin desensitization is not possible) or are not available (e.g. due to stockouts), the WHO STI guideline suggests using, with caution, erythromycin 500 mg orally four times daily for 30 days.

Status

Retired

Recommended in favor

Conditional

Certainty of evidence

Very low