” An infected baby may be born without signs or symptoms but if untreated might develop seizures or die”

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Syphilis

Syphilis is a sexually acquired infection caused by Treponema pallidium. The incidence of syphilis has increased markedly in the last ten years which has been common among homosexual men. The prevalence of Syphilis among pregnant women has been estimated at approximately 68 per million with regional variation. It primarily presents as a painless genital ulcer 3-6weeks after the infection is acquired (condylomatalata). Secondary manifestations occur 6 weeks to six months after and present as a maculopapular rash or lesions affecting the mucous membranes. Ultimately, 20% of untreated patients will develop symptomatic cardiovascular tertiary syphilis and 5-10 percent will develop symptomatic neurosyphilis. 




In pregnant women with early untreated (primary or secondary) syphilis, 70-100% of infants will be infected and approximately 25% will be still born.  Mother to child transmission of syphilis in pregnancy is associated with fetal growth restriction(FGR), fetal hydrops, congenital syphilis (which may cause long term disability), stillbirth, preterm birth, neonatal death. The risk of congenital transmission declines with increasing duration of maternal syphilis prior to pregnancy. Adequate treatment with benzathine penicillin markedly improves the outcome for the fetus. 

Screening for Syphilis 

Routine antenatal screening is recommended for all pregnant women.The body’s immune response to syphilis is the production of non specific and specific treponemal antibodies. These can be detected by serological tests. 

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Treatment 




The initial step is to confirm the diagnosis and to test for any other sexually transmitted disease. Once a diagnosis of syphilis is confirmed, the treatments will equally extend to the spouse. Older children may also need to be screened for congenital infection. Parenteral penicillin has a 98% success rate for preventing congenital syphilis. A jarish-Herxheimer reaction may occur with treatment as a result of pro-inflammatory cytokines in response to dying organisms. Thus fever for 12-24 hours will be noticed after commencement of treatment. It may be associated with uterine contractions and fetal distress. Women should be on admission during the first commencement of treatment. If a woman isn’t treated during pregnancy her baby should be treated after delivery. An infected baby may be born without signs or symptoms of disease but if not treated immediately, may develop serious problems within a few weeks. Untreated babies often develop developmental delay, have seizures or die. 






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