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We consider a patient with syphilis to be treated adequately when the nontreponemal titers fall fourfold or more within 6 to 24 months, depending on stage of disease and patient's HIV status. However, this standard was derived from studies in nonpregnant adults. How (or if) this standard should apply to pregnant women, in whom the overriding concern is preventing congenital syphilis in the neonate, is unclear.
Researchers at a single Texas hospital retrospectively reviewed the serology of 166 pregnant women in whom syphilis was diagnosed at 18 weeks' gestation or later and who were treated with CDC-approved regimens before delivery. Patients were seen between 1981 and 2011. Slightly more than half the women had early disease (primary, second…