The Jarisch-Herxheimer reaction complicating syphilotherapy in pregnancy

Klein, Victor R., Cox, Susan M., Mitchell, Murray D. and Wendel Jr., George D. (1990) The Jarisch-Herxheimer reaction complicating syphilotherapy in pregnancy. Obstetrics and Gynecology, 75 3: 375-380.

Author Klein, Victor R.
Cox, Susan M.
Mitchell, Murray D.
Wendel Jr., George D.
Title The Jarisch-Herxheimer reaction complicating syphilotherapy in pregnancy
Journal name Obstetrics and Gynecology   Check publisher's open access policy
ISSN 0029-7844
Publication date 1990-03
Sub-type Article (original research)
Volume 75
Issue 3
Start page 375
End page 380
Total pages 6
Place of publication New York, N.Y. U.S.A.
Publisher American College of Obstetricians and Gynecologists
Language eng
Subject 1103 Clinical Sciences
1114 Paediatrics and Reproductive Medicine
Abstract Thirty-three gravidas with syphilis were monitored with hourly vital signs and examinations for 24 hours after treatment with benzathine penicillin G. Fifteen (45%) of the subjects had a Jarisch-Herxheimer reaction, including all three, 12 of 20 (60%), and none of ten of those with primary, secondary, and latent syphilis, respectively. The most common symptoms were fever (73%), uterine contractions (67%), and decreased fetal movement (67%). The signs or symptoms began 2-8 hours after treatment; fevers peaked at 6-12 hours post-therapy and the events usually abated by 16-24 hours after treatment. Uterine contractions and decreased fetal activity began concurrent with maternal fever in eight of ten women reporting contractions. Transient late decelerations were detected in three of 11 monitored patients. Three of the women with Jarish-Herxheimer reactions delivered infants with congenital syphilis, including one stillbirth, but none of those without a detectable reaction had fetal treatment failures. Prostaglandin F(2α) and prostacyclin metabolites were elevated transiently in the one subject studied, suggesting their role in mediating the cardiovascular and uterine events in the post-treatment period. The Jarisch-Herxheimer reaction in pregnancy is similar in frequency, character, and intensity to that in nonpregnant adults, but gravidas may have increased uterine activity and transient alterations in fetal well-being. The pregnant patient with a severely affected fetus with congenital syphilis may experience preterm labor, preterm delivery, or fetal death in association with the Jarisch-Herxheimer reaction.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Unknown

Document type: Journal Article
Sub-type: Article (original research)
Collection: UQ Centre for Clinical Research Publications
 
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Created: Thu, 26 Aug 2010, 12:57:51 EST