Syphilis in pregnancy

Syphilis, a sexually transmitted infection, has a major impact on the disease burden worldwide. Globally, an estimated 12 million new cases of sexually acquired syphilis occurred in 1997. Developing countries in Africa, Southeast Asia and regions of the former Soviet Union are mainly affected. With rising numbers of human immunodeficiency virus-infected pregnant women and an increase in gonorrhoea in some areas, the incidence of syphilis is expected to increase again. As a consequence of migration from Eastern bloc countries to Europe after the breakdown of the former Soviet Union, the resurgence of syphilis will also affect Germany. Therefore, we present the clinical picture of syphilis as well as review the current recommendations of the German STD Society, the Centers of Disease Control (CDC), USA, and the Clinical Effectiveness Group (CEG), England, for diagnosis and treatment of syphilis with special emphasis on pregnancy. Considering the current epidemiological situation, physicians should include syphilis in their differential diagnosis. Although recommended therapy regimens differ, penicillin is the treatment of choice. Pregnant patients who are allergic to penicillin should be desensitized and treated with penicillin. Early recognition and timely treatment of syphilis are essential to prevent or treat potentially fatal fetal infection.     

Syphilis in pregnancy

The incidence of syphilis is rising in the UK and more cases of syphilis in pregnancy are being reported. Mother to child transmission of syphilis can result in adverse pregnancy outcomes including miscarriage, still birth, neonatal death, low birthweight, preterm birth and congenital anomalies. These adverse outcomes can be prevented by early diagnosis and prompt treatment of syphilis in pregnancy. This article provides an overview of the condition and focuses on the management during pregnancy.     

妊娠合并梅毒的临床分析

目的 探讨妊娠合并梅毒的临床分期特点及妊娠结局,降低先天梅毒的发生率。方法 根据妊娠期是否行全疗程抗梅毒治疗,将64例经血清学检查确诊为梅毒的孕妇分为两组：治疗组31例,行全疗程抗梅毒治疗,应用苄星青霉素240万单位肌内注射,每周1次连续3周;未治疗组33例,未能行全疗程抗梅毒治疗。比较两组孕妇的妊娠结局。结果（1）64例妊娠合并梅毒患者中,一期5例（7．8％）、二期29例（45．3％）及潜伏梅毒30例（46．9％）;其中治疗组分别为4例、20例及7例,未治疗组分别为1例、9例及23例。（2）治疗组孕妇早产、死胎、死产均为0,新生儿先天梅毒为3例（9．7％）。未治疗组早产4例（12．1）,死胎11例（33．3）,死产3例（9．1）,新生儿先天梅毒10例（30．3）,两组比较,差异有显著性（P＜0．05）。结论 （1）妊娠合并梅毒患者的临床分期以潜伏梅毒为主,由于症状及体征不明显,容易误诊。因此,对梅毒高危妇的常规梅毒筛查特别重要。（2）妊娠合并梅毒患者有不良妊娠结局,但在妊娠期行规范并及早的抗梅毒治疗,能很好地控制早产、死胎,但不能明显降低新生儿先天梅毒的发生。     

Syphilis in pregnancy in Tuscany,description of a case series from a global health perspective

Objective: To estimate the epidemiological impact of syphilis in pregnancy and congenital syphilis in Tuscany and to better delineate their determinants in this region. Methods: Features of pregnant women with syphilis attending the Tuscany Reference Center for Infectious Diseases in Pregnancy between 2000 and 2010 and their infants were retrospectively reviewed. Results: One hundred and eighty-seven pregnancies were observed. The number of pregnancies evaluated increased steadily from 24 in 2000–2002 to 70 in 2009–2010. The majority of women were Italian (20.32%) and East European (44.39%). Eight cases of congenital syphilis were diagnosed (5.60% of pregnancies with known outcome). Italian women had more often an early stage of syphilis (11.76 vs. 1.34%; p = 0.016), an rapid plasma regain (RPR) title ≥ 1:8 (15.79 vs. 5.37%; p = 0.041) and a partner with positive test (60.00 vs. 21.69%; p < 0.001) compared with migrant women. Migrant women received treatment after the first trimester more often compared with Italian ones (40.94 vs. 18.42%; p = 0.013). Conclusions: Syphilis in pregnancy is emerging in Tuscany. Italian and migrant women with syphilis show two different “risk patterns” of vertical transmission. An additional screening test for syphilis in the third trimester and educational campaigns about maternal and sexual health could be effective in combating congenital syphilis in Italy.     

Syphilis

The incidence of syphilis in the United States has almost doubled in the past 5 years, with some cities posting an increase of more than 500% during this period. As a result, greater numbers of neonates infected with congenital syphilis are treated in nurseries across the country. The incidence, pathogenesis, diagnosis, and treatment of syphilis are described, and the nursing implications associated with caring for those at risk of contracting the disease are presented.     

Syphilis

The history, causative agent, diagnosis and treatment of syphilis are described. The causative agent, the spirochete Treponema pallidum, is not routinely grown on laboratory media. The lesion of primary syphilis is usually a painless genital ulcer but chances may appear at other sites. Most patients develop primary disease within 6 weeks of exposure, but the VDRL test is positive in only about 70% of patients with primary syphilis. Secondary syphilis occurs 6 weeks-6 months after the primary inoculation, may have a variety of manifestations, and is diagnosed by serologic studies that are always positive at that stage. Late syphilis develops in about 25% of patients not receiving adequate treatment. Reported cases of primary and secondary syphilis, 27,204 in 1980, and rate of infection/100,000 population, 12.0 in 1980, have been increasing although tertiary syphilis is infrequent. The pathophysiology of the disease is complex because of the interaction of the pathogen and host defense. Syphilis associated with pregnancy presents a special problem because of the risk of fetal infection, but congenital syphilis is preventable and the means for its control are available through public health clinics. Early congenital syphilis, which shows itself within the 1st 2 years, is an infectious life-threatening disease, while late congenital syphilis is usually asymptomatic and may not become manifest for decades. Dark-field microscopic examination is the only absolute diagnosis test for T. pallidum. The VDRL serologic test developed by the Venereal Disease Research Laboratory is widely used as a screening measure, but its accuracy is not absolute. Other tests to confirm diagnoses are available or under development. Penicillin is the antibiotic of choice, although alternative drugs are available for patients with allergies or other contraindications. Dosage schedules vary for different stages of the disease and for congenital syphilis. In all cases of early infectious syphilis the physician should endeavor to see that the source of the infection and those to whom it has been passed are also treated.     

Syphilis in Pregnancy

Syphilis is a chronic infectious process caused by the spirochete Treponema pallidum. In the pregnant woman, syphilis is generally quite easily treated. Long term effects for the mother are rare. Infection during pregnancy may result in spontaneous abortion, stillbirth or premature delivery. The most devastating manifestations are seen in infants born with congenital syphilis. In the HIV-infected pregnant woman who also is infected with syphilis, treatment with the standard regimes may be inadequate. The recent increase in syphilis among women in their childbearing years requires physicians to reacquaint themselves with this disease. The risk factors, manifestations of syphilis, interpretation of serological tests, and management guidelines for the exposed mother are presented.     

Syphilis Resurgent

EDITORIAL COMMENT: Dr Mary Schramm was asked by the editor to provide this editorial to share her unique long-term experience of the treatment of syphilis during pregnancy with readers. Our recent editorial policy is to highlight important sentences in papers in bold print. This paper contains so many punchlines, mostly objective but some interestingly subjective, that readers are advised to read it all with care, since there were far too many important passages for bold-print emphasis of all. This editorial expands the report 'Syphilis in Fiji' provided by Dr Mary Schramm and published in the Pacific Health Dialog 1996; 3: 2: 216–219.