Penicillin desensitization: Treatment of syphilis in pregnancy in penicillin-allergic patients

A 44-year-old gravida 3 para 2 patient with penicillin allergy presented to her obstetrics physician with symptoms and test results concerning for syphilis infection. The allergy and immunology service was consulted for guidance, because treatment with penicillin was deemed necessary. The patient was 27 weeks pregnant and was found at routine prenatal screening to have a positive rapid plasma reagin titer of 1:128 and a positive Treponema palladium immunoglobulin (Ig) G test result. She had blurry vision that began in the first trimester; she also described having had a genital and palmar rash 8 months previously.

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