Syphilis in pregnancy

Abstract

Syphilis can seriously complicate pregnancy and result in spontaneous abortion, stillbirth, nonimmune hydrops, intrauterine growth restriction, and perinatal death, as well as serious sequelae in liveborn infected children. While appropriate treatment of pregnant women often prevents such complications, the major deterrent has been inability to identify the infected women and get them to undergo treatment. Screening in the first trimester with non-treponemal tests such as rapid plasma reagin (RPR) or venereal disease research laboratory (VDRL) test combined with confirmation of reactive individuals with treponemal tests such as the fluorescent treponemal antibody absorption (FTA-ABS) assay is a cost eVective strategy. Those at risk should be retested in the third trimester. Treatment during pregnancy should be with penicillin. In determining a penicillin regimen, the clinician must consider the stage of the maternal infection and the HIV status of the mother. Patients who are allergic to penicillin should be desensitised before treatment. Despite appropriate treatment, as many as 14% will have a fetal death or deliver infected infants. Treatment may further be complicated by the Jarich-Herxheimer reaction, a complex allergic response to antigens released from dead micro-organisms, which can cause fetal distress and uterine contractions. Thanks to eVective intervention strategies and inexpensive penicillin, syphilis rarely complicates pregnancy in the Western world today. In parts of the world where the traditional sexually transmitted diseases have not been controlled, the magnitude of problems associated with syphilis during pregnancy is reminiscent of that faced by the West during the early 1900s. (Sex Transm Inf 2000;76:73-79)

Syphilis screening in Mozambique

“…38 Antenatal screening for syphilis is usually done with non-treponemal tests, either alone or in combination with treponemal tests. 6,9,25,27,28,30,38 However, the use of a treponemal test as the only means to diagnose syphilis has important public health implications. About 20% of pregnant women who had a positive result from the ICSHF test were TPHA-positive/RPR-negative (2.1% of all women tested).…”

“…We chose the RPR as our comparison test because it is widely used in syphilis screening. 6,9,[25][26][27][28][29] Samples of genital mucocutaneous lesions were smeared on glass slides and sent to the University of Washington, Seattle, WA, USA to be tested with use of direct immunofluorescence stain for T. pallidum (ViroStat, Portland, ME, USA). All tests were done in accordance with manufacturers' recommendations.…”

Recent Trends in the Serologic Diagnosis of Syphilis

“…The diagnosis of congenital syphilis is based on a combination of clinical and laboratory evaluations (106). Diagnosis is further complicated because up to 60% of infected infants are asymptomatic at birth or have subtle, nonspecific findings (107,108). Common early signs include hepatosplenomegaly, rash, fever, neurosyphilis, pneumonitis, and snuffles, while common laboratory abnormalities include Coomb's negative hemolytic anemia (58%) and elevated levels of transaminases and alkaline phosphatase in blood (106).…”

Resurgence of early congenital syphilis in Alberta

“…13,14 It is also essential that all sexual partners be tested and treated for syphilis concurrently, to prevent reinfection of the mother.…”