Syphilis in Pregnancy and Congenital Syphilis: Reality in a Portuguese Central University Hospital

Abstract

Purpose To evaluate maternal-fetal surveillance and follow-up of infants at risk for congenital syphilis (CS). Methods Retrospective cohort study in a Portuguese Tertiary Referral Hospital. The main inclusion criterion was a positive syphilis serology. The study included all pregnant women that delivered in our hospital between January 2004 and December 2013. The neonates were classified according to their probability of infection based on the Centers for Disease Control and Prevention guidelines. Results Among the 27 pregnancies at risk for CS, 48.2% (n ¼ 13) of the women had a diagnosis during the 1st trimester, and the median gestational age at the end of the treatment was 28 weeks. Inadequate treatment was noted in 44.4% (n ¼ 12) of the women. Adverse pregnancy outcomes were observed in 30.8% of the cases (n ¼ 8), 5 of which had been adequately treated. We found 2 (7.7%) cases with "proven or highly probable CS," 10 (38.5%) with "possible CS," 12 (46.1%) with "less likely CS," and 2 (7.7%) with "unlikely CS." Among the infants, the treatment was successful, except for 1 neurosyphilis case. Conclusion This study highlights many of the difficulties/concerns encountered in the maternal-neonatal management of syphilis. We highlight the importance of assuring the early detection of the infection as a way of guaranteeing the timely treatment, as well as a good compliance to the treatment and follow-up through a more efficient pregnant women surveillance network.

Prenatal quality and clinical conditions of newborns exposed to syphilis

“…It was observed that 10% of the evaluated infants were preterm, and 12.2% were small for gestational age. These results are lower than those found in a Portuguese study, performed with 27 pregnant women exposed to syphilis during pregnancy, that found 19.2% preterm and small for gestational age 8 . This difference may have occurred because of the lower sample size of this study and the inadequate treatment of maternal disease (44%) 8 .…”

A Retrospective Assessment of Syphilis Seroprevalence among Pregnant Women, Cape Coast, Ghana

“…Thus, congenital syphilis (CS) can manifest, according to the severity, as neonatal death, neonatal disease, or latent infection leading to later sequelae. Unfortunately, delivery at term of live infants who are fully asymptomatic may occur in approximately two-thirds of live born cases with untreated or inappropriately treated mothers [7]. According to a 2012 World Health Organization (WHO) report, an estimated 350,000 adverse pregnancy outcomes worldwide were attributed to syphilis, including 143,000 early fetal deaths/stillbirths, 62,000 neonatal deaths, 44,000 preterm/low-birth-weight babies and 102,000 infected infants [4].…”

Dados alarmantes sobre a notificação de sífilis congênita em uma capital do Norte brasileiro: um estudo transversal

“…Isso representa mais da metade (57,09%) dos casos no Estado do Acre e 2,74% de notificações da região Norte, cifras consideráveis 9,14 . A gravidade desses resultados é evidenciada quando se compara a realidade da capital acreana a um estudo recente que observou apenas 27 casos suspeitos de sífilis congênita em um Hospital Universitário Central de Coimbra, durante os anos 2003 a 2014 15 . Esse período é o dobro do período amostral do presente estudo.…”