A 23-year-old primigravid woman at 14 weeks of gestation presents to the outpatient obstetric clinic for a routine prenatal visit. She has no current symptoms and reports feeling well. Physical examination reveals no genital lesions, rashes, or lymphadenopathy. Routine prenatal laboratory screening is performed, which shows a rapid plasma reagin (RPR) titer of 1:32. A confirmatory Treponema pallidum particle agglutination (TPPA) test is reactive. Her medical history is notable for a severe anaphylactic reaction to amoxicillin during childhood, which manifested as diffuse urticaria, wheezing, and hypotension. Which of the following is the most appropriate pharmacologic intervention for this patient?
- Penicillin allergy desensitization followed by intramuscular penicillin G benzathineCevap
- BOral doxycycline therapy
- COral azithromycin therapy
- DIntravenous ceftriaxone therapy
- EPostpone pharmacologic treatment until the immediate postpartum period
Cevap
Penicillin allergy desensitization followed by intramuscular penicillin G benzathine
This patient has latent syphilis during pregnancy and a documented severe IgE-mediated allergy to penicillin. Penicillin G is the only recommended pharmacologic agent for the treatment of syphilis during pregnancy because it reliably crosses the placenta and prevents congenital syphilis. Alternative regimens either do not adequately treat the fetus or carry unacceptable failure rates. Therefore, pregnant patients with a history of severe penicillin allergy must undergo inpatient oral or intravenous penicillin desensitization, followed immediately by standard intramuscular penicillin G benzathine administration.
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Anahtar Kavram
Pregnant women with syphilis who have a severe penicillin allergy must undergo penicillin desensitization followed by standard penicillin therapy to adequately treat both the mother and the fetus.