Video:Congenital syphilis

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Description

Congenital syphilis is 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 and is a major cause of deaths in babies.[2] It can facilitate the transmission of HIV, and may be preventable with one dose of an inexpensive antibiotic.[1][3]

Mother

Syphilis in pregnancy may have no symptoms.[3] It is typically detected during routine blood screening in early and late pregnancy.[3]

Unborn baby

If an affected pregnant woman is inadequately treated or not treated at all, the unborn baby may become infected.[3] Congenital syphilis may be detected in the unborn baby as poor growth, excessive fluid leading to premature birth, or loss of the baby.[3][4] In some there are no signs.[3][4]

Newborn baby

Features vary widely and may be divided into whether they present before or after age two years.[1] At birth the placenta may appear large and pale.[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] Some babies present with a runny nose, traditionally known as the snuffles.[1] The nasal discharge may initially appear clear, though it may later become yellowy or stained with blood.[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]

Rash of congenital syphilis
Rash of congenital syphilis
Rash of congenital syphilis
Rash of congenital syphilis

Mouth

Small bumps may be seen around the mouth, with cracks and blisters.[1]

Bone pain

Bone involvement may occur in early and late stages, depending on at which trimester the unborn baby became infected. Inflammation around bone or cartilage may cause pain and joint swelling.[1]

Limb movement

It may result in refusal to move a limb.[1]

Eyes

Findings in the eyes include glaucoma, cataracts, chorioretinitis and uveitis.[1]

Other early signs in newborn

Other early onset signs include yellowish skin and eyes, large glands, pneumonia, meningitis, warty bumps on genitals, cleft palate, deafness, or blindness.[1][6]

Later presentation

Untreated babies that survive may develop other skeletal deformities including a saddle nose.[1] Intellectual disability,[1][5] Seizures and cranial nerve palsies may occur in both early and late phases.[1]

Legs

The shins may bow.[1][5]

Jaw and clavicle

Other bone involvement may affect the collar bone, jaw, or cheek bone.[1]

Joint disease

Joint disease may occur.[1]

Clutton's joints
Clutton's joints

Frontal bossing

The forehead may become prominent.[1]

Other

Destruction of skin may occur several years later.[7]

Hard palate

There may be a perforated or high arched palate,[1][5]

Teeth

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]

Diagnosis

The disease may be suspected from tests on the mother, including blood tests and ultrasound.[9] 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]

Prevention

Prevention is by safe sex to prevent syphilis in the mother, and early antenatal screening and treatment of syphilis in pregnancy.[6][11] One intramuscular injection of benzathine penicillin G (2.4MIU) administered to a pregnant woman early in the illness may prevent congenital syphilis in her baby.[3][11]

Epidemiology

In 2016, there were around 473 cases of congenital syphilis per 100,000 live births and 204,000 deaths from the disease worldwide.[12] Of 660,000 cases reported in 2016, 143,000 resulted in deaths of unborn babies, 61,000 deaths of newborn babies, 41,000 low birth weights or preterm births, and 109,000 young children diagnosed with congenital syphilis.[13] 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][14]

References

  1. 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 1.26 1.27 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. 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. 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. 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. 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. 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.
  7. 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.
  8. 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.
  9. "Congenital Syphilis". Centers for Disease Control and Prevention. 1 April 2021. Archived from the original on 13 April 2023. Retrieved 12 May 2023.
  10. 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. 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.
  12. 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)
  13. "Congenital syphilis - Mother-to-child transmission of syphilis". www.who.int. Archived from the original on 21 April 2023. Retrieved 9 May 2023.
  14. 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.