New diagnosis of syphilis in pregnancy with a penicillin allergy — communication and management station

Communication and management station: a new syphilis diagnosis in pregnancy with a reported penicillin allergy. Tests the staging cascade, the benzathine penicillin G regimen, the desensitisation pathway for the allergic woman, the Jarisch-Herxheimer counselling, the partner-notification and confidentiality handling, and the serological follow-up. Includes assessor timeline, marking domains, assessor key and fail criteria.

Prompt

You are the registrar in the antenatal clinic. A 23-year-old G2P1 woman at 20 weeks gestation is found on routine screening to have a reactive RPR at 1:32 with a positive TP-PA. She is asymptomatic on examination. She reports a severe reaction to penicillin as a child — the details are unclear but her mother describes difficulty breathing. She has a new partner of three months who is unaware of the result. The assessor runs the clock and feeds you the woman's responses and the multidisciplinary team inputs.

Station brief

Format. Communication and management station, approximately 12 minutes. You are the registrar in the antenatal clinic. The sexual health physician and the midwife specialist are available by phone. The assessor runs the clock and feeds you the woman's responses and the team inputs. ^[1]

Candidate instruction. Lead the immediate management and counselling of a woman with a new syphilis diagnosis in pregnancy and a reported penicillin allergy. Verbalise your clinical reasoning, your staging, your treatment plan, your handling of the penicillin allergy and partner notification, and your communication with the woman about the Jarisch-Herxheimer reaction and the serological follow-up. ^[1]^[3]

References3Show

[1]Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021 MMWR Recomm Rep, 2021.PMID 34292926
[2]Klein VR, Cox SM, Mitchell MD, et al. The Jarisch-Herxheimer reaction complicating syphilotherapy in pregnancy Obstet Gynecol, 1990.PMID 2304710
[3]Desjardins AA, Amaral E, Miranda J, et al. Syphilis in pregnancy: a practical guide for prenatal care providers Int J Gynaecol Obstet, 2025.PMID 40977496

New diagnosis of syphilis in pregnancy with a penicillin allergy — communication and management station

Station brief

References3Show

[1]Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021 MMWR Recomm Rep, 2021.PMID 34292926
[2]Klein VR, Cox SM, Mitchell MD, et al. The Jarisch-Herxheimer reaction complicating syphilotherapy in pregnancy Obstet Gynecol, 1990.PMID 2304710
[3]Desjardins AA, Amaral E, Miranda J, et al. Syphilis in pregnancy: a practical guide for prenatal care providers Int J Gynaecol Obstet, 2025.PMID 40977496