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Usband, a 21-year old chef denied any high-risk behavior previously. On arrival, she was currently in sophisticated labor and delivered a macerated stillbirth child boy, weighing 1.48 kg. Grossly it looked normal with no facial dysmorphism.Blood investigation taken in the course of admission noted that her RPR was reactive at 1:64 titrations, with good syphilis IgG antibody. She was explained about syphilis and pregnancy and offered remedy but she requested to follow-up in a different hospital. Her husband was also counseled but did not agreed for blood testing. DISCUSSION Syphilis is among the sexually transmitted infections. Planet Health Organization (WHO) estimates practically 1.five millions of pregnant girls are infected with probable active syphilis every year and roughly, half of your untreated pregnant women suffer adverse outcome through pregnancy.1 Porcupine Inhibitor Biological Activity antenatal screening for syphilis offers a fantastic opportunity to JAK manufacturer detect the illness early. Those218 Pak J Med Sci 2015 Vol. 31 No. 1 pjms.pkwho attended antenatal care but were not supplied syphilis testing have already been shown to possess adverse outcome of the illness.2 In Malaysia, antenatal screening test for syphilis by non-treponemal serology test is encouraged during the first visit and subsequently at 28 week of gestation.3 Syphilis is often divided into quite a few stages: primary, secondary, latent and tertiary syphilis. Clinical manifestations of syphilis are not apparently altered by pregnancy.4 Vertical transmission can take place at any time and stage of syphilis. Threat of transmission correlates with the extent of spirochetes presence in the blood circulation, as a result primary and secondary syphilis carry a greater danger of transmission than latent and tertiary syphilis.5 The lesions of key syphilis take place about 3 weeks just after sexual speak to and they’re generally unrecognized in girls simply because they could be asymptomatic.five Based on clinical history obtained, each of our situations have been most likely in the early stage of syphilis (main, secondary or early latent). Congenital syphilis will be the most devastating complication of syphilis in pregnancy. The manifestation of congenital syphilis will depend on quite a few factors; gestational age, stage of maternal syphilis, maternal remedy and immunological response with the fetus.5 Pregnancies complicated by syphilis may perhaps lead to intra-uterine development restriction, non-immune hydrops fetalis, stillbirth, preterm delivery and spontaneous abortion4. In our circumstances, two various fetus outcomes had been noticed. In Case 1 no obvious clinical characteristics of congenital syphilis were noticed though in Case 2, the patient had a stillbirth. Syphilis in pregnancy is diagnosed within a related technique to the non-pregnant population. Serological tests remain the mainstay for the diagnosis whereby the tests can be divided into two major categories namely non-treponemal tests (i.e. RPR, VDRL) and specific treponemal antibody tests. In our laboratory, we use RPR as our screening laboratory test for syphilis, that is additional confirmed by treponemal-based test; syphilis IgM and IgG. Antenatal laboratory test for syphilis plays an essential function for the diagnosis, since it is clearly shown that the timing of antenatal care interventions makes a substantial difference within the risk of possessing an adverse outcome because of syphilis.six High RPR titer at diagnosis is related to improved threat of vertical transmission.7 It truly is also evident that those who are persistently negative in non-treponemal test will not transmit syphilis vertically.8.