Syphilis in Pregnancy and Its Affects On Newborn Signs Diagnosis and Treatment

Syphilis:

•          Caused By Treponema pallidum (spirochete)

•          Transmitted via sexual contact

•          Placental transmission as early as 6wks gestation

•          Typically occurs during the second half

•          Mom with primary or secondary syphilis is more likely to transmit than the latent disease

•          Large decrease in congenital syphilis since the late 1990s

•          In 2002, only 11.2 cases/100,000 live births reported

Congenital Syphilis

•          2/3 of affected live-born infants are asymptomatic at birth

•          Clinical symptoms split into early or late (2 years is cut off)

•          3 major classifications:

•          Fetal effects

•          Early effects

•          Late effects

Clinical Manifestations

Fetal:

•          Stillbirth

•          Neonatal death

•          Hydrops fetalis

•          Intrauterine death in 25%

•          Perinatal mortality in 25-30% if untreated

Early congenital (typically 1^st 5 weeks):

•          Cutaneous lesions (palms/soles)

•          HSM

•          Jaundice

•          Anaemia

•          Snuffles

•          Periostitis and metaphysical dystrophy

•          Funisitis (umbilical cord vasculitis)

Late congenital:

•          Frontal Bossing

•          Short maxilla

•          High palatal arch

•          Hutchinson's teeth

•          8^th nerve deafness

•          Saddle nose

•          Perioral fissures

•          Can be prevented with appropriate treatment

Hutchinson Teeth appear in late Congenital Syphilis

Diagnosing Syphilis ( not in newborns )

•          Available serologic testing

•          RPR/VDRL:  nontreponemal test

•          Sensitive but NOT specific

•          Quantitative, so can follow to determine disease activity and treatment response

•          MHA-TP/FTA-ABS:  specific treponemal test

•          Used for confirmatory testing

•          Qualitative, once positive always positive

•          RPR/VDRL screen in ALL pregnant women early in pregnancy and at time of birth

•          This is easily treated!!

CDC Definition of Congenital Syphilis:

•          Confirmed if T. pallidum identified in skin lesions, placenta, umbilical cord, or at autopsy

•          Presumptive diagnosis if any of:

•          Physical exam findings

•          CSF findings (positive VDRL)

•          Osteitis on long bone x-rays

•          Funisitis (“barber shop pole” umbilical cord)

•          RPR/VDRL >4 times the maternal test

•          Positive IgM antibody

•          IgG can represent maternal antibody, not infant infection

•          This is VERY intricate and often confusing

•          Consult your RedBook (or peds ID folks) when faced with this situation

Treatment:

•          Penicillin G is THE drug of choice for ALL syphilis infections

•          Maternal treatment during pregnancy very effective (overall 98% success)

•          Treat newborn if:

•          They meet CDC diagnostic criteria

•          Mom was treated <4wks before delivery

•          Mom treated with non-PCN med

•          Maternal titers do not show adequate response (less than 4-fold decline)