Syphilis

Diagnostic criteria

General measures

Medicine treatment

---

O98.1

DIAGNOSTIC CRITERIA

Most pregnant women infected with syphilis are asymptomatic.
See: Syphilis serology and treatment.

GENERAL MEASURES

Inform contact(s).

MEDICINE TREATMENT

Mother (treat as either early or late latent/unknown or early stage of syphilis):

For late latent syphilis or syphilis of unknown duration

• Benzathine benzylpenicillin (depot formulation), IM, 2.4 million units diluted in 6 mL 1% lidocaine without adrenaline (epinephrine), weekly for 3 doses.

---

Note: If the mother has received <3 doses, treat the baby for congenital syphilis.

---

LoE:IIIb^xxv

For early syphilis

• Benzathine benzylpenicillin (depot formulation), IM, 2.4 million units diluted in 6 mL 1% lidocaine without adrenaline (epinephrine), immediately as a single dose.

Severe penicillin allergy Z88.0

• For penicillin sensitive pregnant women: penicillin desensitisation.
  Perform only in an ICU setting or in a setting where recognition and management of anaphylaxis can be assured. See “How to Use These Guidelines” for detailed information.

Oral penicillin desensitisation protocol

After step 14, observe for 30 minutes, then administer desired dose of intramuscular penicillin.

Click on image to enlarge

---

Note:
- Repeat desensitisation is not required for subsequent doses of the same treatment course (e.g., to complete 3 doses of benzathine benzylpenicillin for late latent syphilis or syphilis of unknown duration).
- However, second and third doses must be administered in a hospital setting.

---

Asymptomatic, well baby:

Mother has syphilis and has not been treated, or was only partially treated:

• Benzathine benzylpenicillin (depot formulation), IM, 50 000 units/kg as a single dose into the antero-lateral thigh.

Symptomatic baby

• Procaine penicillin, IM, 50 000 units/kg daily for 10 days. (Not for IV use).

OR

• Benzylpenicillin (Penicillin G), IV, 50 000 units/kg, 12 hourly for 10 days.

Click here to access the pdf.

---

Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2025-9 Review_Version 2.0_26 March 2026

Chapter 6 Obstetrics_6.7 Syphilis