Gestational syphilis with nonadherence to antibiotic treatment despite regular follow-up in primary care

Abstract

Objective: To report a clinical case of gestational syphilis diagnosed at the second prenatal visit in a primary-care service, in a patient who did not complete the indicated antibiotic treatment despite attending her visits regularly.

Methods: We present the case of a 19-year-old primigravida with no relevant personal history, enrolled in prenatal care at 17 weeks of gestation at the Cafetal Guaraní Family Health Unit (USF) in Salto del Guairá, in whom a positive VDRL was detected at the second visit, at 32 weeks.

Results: Treatment with benzathine penicillin G (2 400 000 IU weekly for 3 weeks) was indicated, with counseling on the Jarisch-Herxheimer reaction, but the patient did not receive the medication. At the third visit, at 34 weeks and 3 days, with VDRL again positive, the same regimen was reindicated and again not completed; she remained without antibiotic treatment until 39 weeks, when she was referred to hospital with probable latent syphilis in the setting of imminent delivery. The newborn had a reactive VDRL at birth; mother and child were discharged after completing treatment and remain under epidemiological follow-up, with psychological support for the couple.

Conclusion: This case illustrates that timely detection of gestational syphilis in primary care does not by itself guarantee a favorable outcome if nonadherence to treatment is not actively addressed, and underscores the need for intervention strategies centered on the physician–patient relationship and on each pregnant woman’s individual context.