A Case Report of Delayed Syphilis Diagnosis in Pregnancy

Aims: To report a case of primary genital syphilis in a pregnant woman, which is atypical due to the delayed diagnosis, course of the disease and to emphasize its reasons and clinical management.

Presentation of Case: We present a pregnant primiparous woman G1P0A0 complaining of pain and growing lesion in the perineal area. She was misdiagnosed and unsuccessfully treated for the perineal abscess several times. The diagnosis of syphilis was delayed because of the negative prenatal syphilis test result in the first trimester. The negative test result misled doctors into immediately dismissing the diagnosis of syphilis. In addition to the delayed diagnosis, after the correct diagnosis regardless of an appropriate treatment with benzathine penicillin G, the pain and the chancre recurred possibly due to the reinfection during intercourse with an infected partner.

Discussion: Diagnosing syphilis may be complicated itself. In this case there were several factors that made the correct diagnosis and successful treatment even more difficult. These were: negative prenatal screening, reinfection and recurrence of the symptoms after treatment.

Conclusion: With this case we emphasize the importance to repeat the syphilis testing if the diagnosis of syphilis is suspected, regardless of previous negative first trimester syphilis screening result and importance of sexual partner’s screening and treatment if infected.