Video:Congenital syphilis
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Description
Congenital syphilis is a preventable syphilis that occurs when a mother with untreated syphilis passes the infection to her baby during pregnancy.[1] Globally it affects around one million pregnancies a year, is a major cause of deaths in babies,[2] and can facilitate the transmission of HIV.[1][3]
Mother
In the mother, syphilis in pregnancy may present with symptoms of the varying stages of syphilis, or may have no symptoms.[3] It is typically detected during routine blood screening in early and late pregnancy.[3]
Unborn baby
Without adequately treating an affected mother, the unborn baby may become infected.[3] An infected unborn baby may present with poor growth, excessive fluid leading to premature birth, or stillbirth.[3][4] In some there are no signs.[3][4]
Newborn baby1
Features may be divided into whether they present soon after birth or later.[1] Typically there are no signs in the first few weeks of life, though an affected baby may be small, dehydrated, malnourished, and irritable.[1]
Newborn baby2
Some affected babies present with the snuffles, a traditional term for a runny nose that is clear at first, though it may later become yellowy or blood stained.[1] A fever with or without a large liver and spleen may be present.[1][5]
Rash
The distinctive rash may appear as light coloured patches on the legs and face, or as widespread peeling skin.[1]
Palms and soles
There may be dark spots on the palms of hands or soles of feet.[1]
Mouth
Small bumps may be seen around the mouth, with cracks and blisters.[1]
Other early signs in newborn1
Other early onset signs include yellowish skin and eyes, large glands, pneumonia, meningitis, warty bumps on genitals, and deafness, or blindness.[1][6]
Other early signs in newborn2
There may be a cleft palate.[1] Intellectual disability,[1][5] seizures and cranial nerve palsies may occur in both early and late phases.[1]
Eyes
Findings in the eyes may include glaucoma, cataracts, chorioretinitis and uveitis.[1]
Late phase
Untreated babies that survive may develop skeletal deformities.[1]
Head
In the head, these may include a saddle nose, deformity of the jaw, cheek bone, or prominence of the collar bone.[1]
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Teeth
Some teeth may appear small, notched or pointy.[2] This is generally specific for congenital syphilis when it appears along with interstitial keratitis and sensorineural hearing loss.[2]
Hard palate
There may be a perforated or high arched palate,[1][5]
Frontal bossing
The forehead may appear prominent.[1]
Limbs and joints
Inflammation around bone or cartilage may cause pain and joint swelling, particularly in arms and legs.[1]
Limb movement
It may result in refusal to move a limb.[1]
Legs
The shins may bow.[1][5]
Other
Destruction of skin may occur several years later.[7]
Cause
It is caused by the bacterium Treponema pallidum subspecies pallidum when it infects the baby after crossing the placenta during pregnancy or from contact with a syphilitic sore at birth.[1][4] It is not transmitted during breastfeeding unless there is a syphilitic sore on the mother's breast.[1] Most cases occur due to inadequate screening and treatment during pregnancy.[8] The baby is highly infectious if the rash and snuffles are present.[1]
Diagnosis1
Congenital syphilis may be suspected from tests on the mother, including blood tests and ultrasound.[9]
Diagnosis2
Tests on the baby may include blood, CSF, and medical imaging.[10] Findings may reveal low red blood, low platelets, low sugars, protein in the urine, or low thyroid.[1] The placenta may appear large and pale.[1] Other investigations include testing for HIV.[10]
Prevention1
Prevention is by safe sex, early antenatal screening and treatment of syphilis in pregnancy.[6][11]
Prevention2
One intramuscular injection of benzathine penicillin G administered to a pregnant woman early in the illness may prevent congenital syphilis in her baby.[3][11]
Epidemiology1
Cases of congenital syphilis had been declining in the United States.[2]
Epidemiology2
However, since 2012, it has been on the rise.[2] In 2016, there were around 473 cases of congenital syphilis per 100000 live births and 204000 deaths from the disease worldwide.[12] Around 75% were from the African and Eastern Mediterranean regions.[5] The cost of preventing syphilis in the mother and baby and in treating the disease is generally inexpensive.[11][13]
History
Historically, it has been associated with stigma and disgrace.[14]
References
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 1.23 1.24 1.25 Medoro, Alexandra K.; Sánchez, Pablo J. (June 2021). "Syphilis in Neonates and Infants". Clinics in Perinatology. 48 (2): 293–309. doi:10.1016/j.clp.2021.03.005. ISSN 1557-9840. PMID 34030815. Archived from the original on 2022-07-20. Retrieved 2023-05-10.
- ↑ 2.0 2.1 2.2 2.3 2.4 Hussain, Syed A.; Vaidya, Ruben (2023). "Congenital Syphilis". StatPearls. StatPearls Publishing. PMID 30725772. Archived from the original on 2022-12-10. Retrieved 2023-05-12.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Ghanem, Khalil G.; Hook, Edward W. (2020). "303. Syphilis". In Goldman, Lee; Schafer, Andrew I. (eds.). Goldman-Cecil Medicine. Vol. 2 (26th ed.). Philadelphia: Elsevier. p. 1986. ISBN 978-0-323-55087-1. Archived from the original on 2023-06-30. Retrieved 2023-05-08.
- ↑ 4.0 4.1 4.2 James, William D.; Elston, Dirk; Treat, James R.; Rosenbach, Misha A.; Neuhaus, Isaac (2020). "18. Syphilis, Yaws, Bejel, and Pinta". Andrews' Diseases of the Skin: Clinical Dermatology (13th ed.). Edinburgh: Elsevier. pp. 347–361. ISBN 978-0-323-54753-6. Archived from the original on 2023-06-30. Retrieved 2023-05-11.
- ↑ 5.0 5.1 5.2 5.3 5.4 Adamson, Paul C.; Klausner, Jeffrey D. (2022). "60. Syphilis (Treponema palladium)". In Jong, Elaine C.; Stevens, Dennis L. (eds.). Netter's Infectious Diseases (2nd ed.). Philadelphia: Elsevier. pp. 339–347. ISBN 978-0-323-71159-3. Archived from the original on 2023-07-06. Retrieved 2023-07-05.
- ↑ 6.0 6.1 "STD Facts - Congenital Syphilis". www.cdc.gov. 10 April 2023. Archived from the original on 21 April 2023. Retrieved 9 May 2023.
- ↑ Fang, Juliet; Partridge, Elizabeth; Bautista, Geoanna M; Sankaran, Deepika (December 2022). "Congenital Syphilis Epidemiology, Prevention, and Management in the United States: A 2022 Update". Cureus. 14 (12): e33009. doi:10.7759/cureus.33009. ISSN 2168-8184. PMID 36712768.
{{cite journal}}: CS1 maint: unflagged free DOI (link) - ↑ Gilmour, Leeyan S.; Walls, Tony (15 March 2023). "Congenital Syphilis: a Review of Global Epidemiology". Clinical Microbiology Reviews: e0012622. doi:10.1128/cmr.00126-22. ISSN 1098-6618. PMID 36920205. Archived from the original on 30 June 2023. Retrieved 12 May 2023.
- ↑ "Congenital Syphilis". Centers for Disease Control and Prevention. 1 April 2021. Archived from the original on 13 April 2023. Retrieved 12 May 2023.
- ↑ 10.0 10.1 "Congenital Syphilis - STI Treatment Guidelines". www.cdc.gov. 19 October 2022. Archived from the original on 1 April 2023. Retrieved 9 May 2023.
- ↑ 11.0 11.1 11.2 WHO guideline on syphilis screening and treatment for pregnant women. Geneva: World health Organization. 2017. ISBN 978-92-4-155009-3. Archived from the original on 2023-06-30. Retrieved 2023-05-10.
- ↑ Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021 (PDF). Geneva: World Health Organization;. 2021. ISBN 978-92-4-003098-5. Archived (PDF) from the original on 2023-03-26. Retrieved 2023-05-08.
{{cite book}}: CS1 maint: extra punctuation (link) - ↑ Akhtar, F; Rehman, S (16 January 2018). "Prevention of Congenital Syphilis Through Antenatal Screenings in Lusaka, Zambia: A Systematic Review". Cureus. 10 (1): e2078. doi:10.7759/cureus.2078. PMID 29560291. Archived from the original on 11 March 2023. Retrieved 10 May 2023.
{{cite journal}}: CS1 maint: unflagged free DOI (link) - ↑ Tampa, M; Sarbu, I; Matei, C; Benea, V; Georgescu, SR (15 March 2014). "Brief History of Syphilis". Journal of Medicine and Life. 7 (1): 4–10. ISSN 1844-122X. PMID 24653750.