Pregnancy and STDs

[StrangerX]

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If a pregnant woman has a + VRDL (but no other signs or symptoms of syphillis) and you are waiting on the confirmatory test, can you still treat with penicillin?

If a pregnant woman's partner has gonorrhea or chlamydia but she doesn't have signs or symptoms, can you begin treating the patient without the the test results (i.e. culture or NAAT)?

I believe in a non-pregnant woman I think you wouldn't in the former until a confirmatory test came back (or unless they had clinical signs or symptoms) and in the latter in a non-pregnant woman I think you wouldn't just give the patient meds without a positive test or signs or symptoms. However I am not so certain about the pregnant women. On the one hand you want to get the diagnosis before treating unnecessarily but on the other hand if you wait, you could risk congenital anomalies.

 

[evilbooyaa]

I am not 100% sure on the answer to this, but considering all infections are treated, I don't think it could hurt to just treat it.
Penicillin, Ceftriaxone, and Azithromycin are all safe to give during pregnancy. If it was a test question and they mentioned she was VDRL positive, I'm treating syphillis (unless they're going for anti-phospholipid antibody w/ hx of multiple SABs). If they mention her partner had G/C, I'm probably getting a swab before I auto-treat.

 

[futuredoctor10]

I am not 100% sure on the answer to this, but considering all infections are treated, I don't think it could hurt to just treat it.
Penicillin, Ceftriaxone, and Azithromycin are all safe to give during pregnancy. If it was a test question and they mentioned she was VDRL positive, I'm treating syphillis (unless they're going for anti-phospholipid antibody w/ hx of multiple SABs). If they mention her partner had G/C, I'm probably getting a swab before I auto-treat.

I think this sounds like good management. With the partner being G/C positive, it makes sense to swab first then treat.

Also unrelated to the OP post: fluconazole and metronidazole are safe in pregnancy, so for these lower genital tract infections (Candida, BV, Trich) you can use above medications as you would in the non-pregnant patient. 🙂

Great review for what to do in the pregnant patients!

 

[StrangerX]

Slightly different but related question...what would you guys do for possible varicella exposure in a pregnant woman...treat with VZIG on exposure first OR check for titers first (given then she is probably more likely immune that not as most people usually are)?

 

[Rebs28]

If a pregnant woman has a + VRDL (but no other signs or symptoms of syphillis) and you are waiting on the confirmatory test, can you still treat with penicillin?

I had a Kaplan question like this, and the answer was to wait for the confirmatory test.

I do remember that this was in a penicillin allergic patient, so perhaps if she's not allergic you would go ahead and treat.

 

[AndyRSC]

Varicella exposure in a pregnant woman...treat with VZIG on exposure first OR check for titers first?

The answer is based on timeframe of exposure. If exposure within 96 hours, give VZIG.

 

[Rebs28]

Slightly different but related question...what would you guys do for possible varicella exposure in a pregnant woman...treat with VZIG on exposure first OR check for titers first (given then she is probably more likely immune that not as most people usually are)?

NM, as above. But I would never check titers before treating, as this takes too long.

 

[DrMattOglesby]

recall that anti-phospholipid syndromes can produce a false positive VDRL on lab results. If they test positive for RPR too though, then they may have asymptomatic syphilis.