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A pregnant 26-year-old G1 at 22 weeks has a reactive RPR 1:64 with confirmatory treponemal antibody. She reports a severe penicillin allergy with anaphylaxis. What is the most appropriate management?
Penicillin desensitization followed by benzathine penicillin G treatment; this is the only effective regimen for syphilis in pregnancy.
Defer treatment until after delivery.
Ceftriaxone 1 g IV daily x 14 days.
Doxycycline 100 mg PO BID x 28 days.
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