EXPLANATION FOR QUESTION 22

 QUESTION 22

Treponema pallidum readily crosses the placenta and is associated with many adverse fetal outcomes, including intrauterine
growth
restriction, fetal death, and congenital infection. All pregnant women should be screened for syphilis at their first prenatal
visit
as treatment effectively reduces fetal risk. Screening may be done with either a nontreponemal test (eg, VDRL} or treponemalspecific test (eg, fluorescent treponemal antibody absorption), but a positive test result requires confirmation (with the other test type}
as the rate of false positives is high
Pregnant patients with syphilis require treatment with penicillin as alternate antibiotic choices are ineffective, contraindicated, or have
limited data in pregnancy. Patients with penicillin allergy should have a penicillin skin test to evaluate for the presence of an lgEmediated response If the test is positive, patients are desensitized to penicillin prior to receiving treatment with intramuscular
pen
icillin G benzathine.
(Choices A and 0) Azithromycin and erythromycin do not reliably cure maternal or fetal infection as Tpatlidium is often macrolideresistant.
(Choice 8) Ciprofloxacin is not an effective antibiotic for the treatment of syphilis
(Choice C) Nonpregnant patients with penicillin allergy are typically given doxycycline to treat early syphilis However, doxycycline is
cont
raindicated in pregnancy due to issues with fetal bone growth
(Choice E) Syphilis infection puts both the mother and fetus at great risk of complications. Delaying treatment is inadvisable.
Educational objective:
Treatment with penicillin is required for all pregnant patients with syphilis to prevent fetal complications Patients with penicillin allergy
shoul
d receive skin testing to confirm an lgE-mediated reaction. If the test is positive, patients are desensitized to penicillin prior to
rece
iving treatment with intramuscular penicillin G benzathine

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