A pregnant woman in her first trimester is found to have a reactive VDRL (1:16) and a reactive TPHA (TPPA). She has no symptoms. The most appropriate management is:

• A Oral doxycycline 100 mg twice daily for 14 days
• B Oral azithromycin 2 g single dose
• C IV aqueous penicillin G 18–24 million units/day for 10 days
• D Single-dose benzathine penicillin G 2.4 million IU IM ✓

Explanation

Early latent syphilis in pregnancy is treated with benzathine penicillin G 2.4 million IU IM single dose. Penicillin G is the only antibiotic proven to prevent congenital syphilis and treat the fetus in utero. Doxycycline is contraindicated in pregnancy. Azithromycin resistance is common in Treponema pallidum globally and not recommended in pregnancy. IV aqueous penicillin is reserved for neurosyphilis. All pregnant women should be screened with VDRL/RPR at first antenatal visit.

Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.