Congenital Syphilis

1
Congenital Syphilis

• Irina Tabidze, MD, MPH and
• Thad Zajdowicz, MD, MPH
• STD/HIV Division
• Chicago Dept of Public Health

2
Congenital Syphilis (CS)

• Syphilis is a chronic infection caused by the
  spirochete Treponema pallidum, which is of
  particular concern during pregnancy because of
  the risk of transplacental infection of the
  fetus.
• Congenital infection is associated with several
  adverse outcomes, including
• -Perinatal death
• -Premature delivery
• -Low birth weight-Congenital anomalies

3
Modes of Transmission

• Sexual contact.
• Trans-placental passage from infected mother.
• Contact with lesion at the time of delivery.
• The risk of developing syphilis after exposure is
  about 40.

4
Risk Factors for CS

• Lack of or inadequate prenatal care.
• Maternal substance abuse.
• Failure to repeat a serological test for syphilis
  in the third trimester.
• Treatment failure.
• Inadequate access to Sexually Transmitted
  Diseases (STD) clinics and STD outreach
  activities.

5
Epidemiology of CS

• Incidence of CS reflects the rate of syphilis in
  women of childbearing age.
• Peaks in CS occur one year after peaks in PS
  syphilis in women.

6
Congenital syphilis Rates for infants lt1 year
of age US, 19812002 and the Healthy People 2010
objective
Rate (per 100,000 live births)
125
Cong. Syphilis
2010 Objective
100
75
50
25
0
1981
83
85
87
89
91
93
95
97
99
2001
Note The Healthy People 2010 objective for
congenital syphilis is 1.0 case per 100,000 live
births. The surveillance case definition for
congenital syphilis changed in 1988.
7
Congenital syphilis Reported cases for infants
lt1 year of age and rates of P S syphilis among
women US, 19702002
PS rate (per 100,000 population)
CS cases (in thousands)
20
7.5
Kaufman Criteria
16
6.0
CDC Surveillance
Definition
12
4.5
PS Syphilis
8
3.0
Congenital
4
1.5
Syphilis
0
0.0
1970
75
80
85
90
95
2000
Note The surveillance case definition for
congenital syphilis changed in 1988.
8
Syphilis in Newborns

• Two-thirds of live-born neonates with CS are
  asymptomatic at births.
• Overt infection can manifest in the fetus, the
  newborn, or later in childhood.
• The infant may have many or even no signs until
  6-8 weeks of life (delayed form).
• Clinical manifestations after birth are divided
  arbitrarily into
• - Early CS (lt2 years of age) and
• - Late CS ( gt2 years of age)

9
Clinical Manifestations of Early CS

• Condyloma Lata
• Maculopapular rash
• Hepatosplenomegaly
• Jaundice due to the hepatitis
• Anemia
• Osteochondritis
• Snuffles
• Pseudoparalysis

• Lymphadenopathy
• Mucous patches

10
Congenital Syphilis
11
(No Transcript)
12
Congenital Syphilis
13
Congenital Syphilis
14
Congenital Syphilis
15
Clinical Manifestations of Late CS

• Hutchinsons triad (63)
• -Hutchinsons teeth (blunted upper incisors)
• -Interstitial keratitis
• -VII nerve deafness
• Frontal bossae (bony prominences of the forehead)
  (87)

• Saddle nose (74)
• Defect of hard pallet
• Cluttons joints (bilateral painless swelling of
  knees)
• Saber chins
• Short maxillas
• Protruding mandible

16
Congenital Syphilis
Hutchinsons Triad (late congenital
syphilis) Interstitial keratitis Teeth
abnormalities Deafness
17
Congenital Syphilis
18
Cluttons Joints
19
Saddle Nose
20
Sabre Shins
21
Laboratory Diagnosis

• Direct visualization
• Darkfield examination of exudate
• Direct fluorescent antibody to T. pallidum
• Serologic testing
• - Nontreponemal Antibody tests (VDRL test and
  RPR test)
• - Treponemal Antibody tests (FTA-ABS and MHA-TP)

22
Interpretation of the Syphilis Serology of
Mothers their Infants
Treponemal Test
Nontreponemal Test
Interpretation No syphilis or incubating
syphilis in the mother and infant
Infant
Infant
Mother
Mother
-
-
-
-
-
-


No syphilis in mother
Maternal syphilis with possible infant infection


or -

Recent or previous syphilis in the mother
possible infection in infant





-

-
Mother successfully treated for
syphilis before or early in
pregnancy
23
Maternal Treatment

• Penicillin is the gold standard for the treatment
  of syphilis.
• Pregnant women with syphilis should be treated
  with the appropriate penicillin regimen according
  to their stage of disease.
• Sexually Transmitted Diseases Treatment
  Guidelines 2002. MMWR 2002 51 (No. RR-6)
  19-23

24
Treatment of Infants

• Sexually Transmitted Diseases Treatment
  Guidelines 2002. MMWR 2002 51 (No. RR-6)
  26-28

25
Follow-up evaluation

• Non-treponemal antibody serologic testing should
  be checked at 1, 3, 6, 12 and 24 months following
  treatment.
• Titers should decrease four-fold by 6 months post
  therapy and become non-reactive by 12 to 24
  months.
• Titers that show a four-fold rise or do not
  decrease suggest either treatment failure or
  re-infection.