Usband, a 21-year old chef denied any high-risk behavior previously. On arrival, she was already in sophisticated labor and delivered a macerated stillbirth baby boy, weighing 1.48 kg. Grossly it looked typical with no facial dysmorphism.Blood investigation taken during admission noted that her RPR was reactive at 1:64 titrations, with good syphilis IgG antibody. She was explained about syphilis and pregnancy and supplied remedy but she requested to follow-up in one more hospital. Her husband was also counseled but did not agreed for blood testing. DISCUSSION Syphilis is one of the sexually transmitted infections. World Health Organization (WHO) estimates nearly 1.five millions of pregnant girls are infected with probable active syphilis every single year and around, half of the untreated pregnant females suffer adverse outcome during pregnancy.1 Antenatal screening for syphilis provides a good opportunity to detect the disease early. Those218 Pak J Med Sci 2015 Vol. 31 No. 1 pjms.pkwho attended antenatal care but weren’t provided syphilis testing have been shown to have adverse outcome in the disease.2 In Malaysia, antenatal screening test for syphilis by non-treponemal serology test is suggested throughout the initial go to and subsequently at 28 week of gestation.three Syphilis is often divided into a number of stages: principal, secondary, latent and tertiary syphilis. Clinical manifestations of syphilis are usually not apparently altered by pregnancy.4 Vertical transmission can take place at any time and stage of syphilis. Risk of transmission correlates together with the NTR1 custom synthesis extent of spirochetes presence inside the blood circulation, therefore main and secondary syphilis carry a higher risk of transmission than latent and tertiary syphilis.5 The lesions of main syphilis take place about three weeks immediately after sexual speak to and they may be normally unrecognized in girls simply because they could be asymptomatic.five Primarily based on clinical history obtained, both of our situations had been likely at the early stage of syphilis (principal, secondary or early latent). Congenital syphilis is definitely the most devastating complication of syphilis in pregnancy. The manifestation of congenital syphilis will EBI2/GPR183 Synonyms depend on a lot of elements; gestational age, stage of maternal syphilis, maternal therapy and immunological response in the fetus.5 Pregnancies complex by syphilis might result in intra-uterine growth restriction, non-immune hydrops fetalis, stillbirth, preterm delivery and spontaneous abortion4. In our situations, two different fetus outcomes were noticed. In Case 1 no apparent clinical functions of congenital syphilis were observed while in Case two, the patient had a stillbirth. Syphilis in pregnancy is diagnosed inside a comparable approach to the non-pregnant population. Serological tests stay the mainstay for the diagnosis whereby the tests may be divided into two principal categories namely non-treponemal tests (i.e. RPR, VDRL) and distinct treponemal antibody tests. In our laboratory, we use RPR as our screening laboratory test for syphilis, which can be further confirmed by treponemal-based test; syphilis IgM and IgG. Antenatal laboratory test for syphilis plays a crucial role for the diagnosis, as it is clearly shown that the timing of antenatal care interventions tends to make a important distinction within the risk of getting an adverse outcome because of syphilis.6 Higher RPR titer at diagnosis is related to elevated danger of vertical transmission.7 It can be also evident that these who are persistently damaging in non-treponemal test is not going to transmit syphilis vertically.8.