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Amendment to the UK guidelines on the management of syphilis 2015: Management of syphilis in pregnant women

The guideline authors have provided clinical advice on the management of the babies born with congenital syphilis, as well as regularly providing clinical advice and support to doctors and midwives who are managing pregnant women with positive syphilis serology. We have noted that the continued option of macrolides within the UK guidelines for the management of syphilis in pregnancy, even with the stated caveats and cautions, provides a treatment option that is suboptimal and results in treatment failure with significant adverse outcomes reported. Macrolide antibiotics do not cross the placenta well to treat a foetus that may be affected by syphilis and Treponema pallidum has unacceptably high rates of macrolide resistance reported.3-5