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PubMed2004

Evaluation of a Treponema pallidum-specific IgM enzyme immunoassay and Treponema pallidum western blot antibody detection in the diagnosis of maternal and congenital syphilis.

BACKGROUND: Congenital syphilis (CS) is a result of untreated or inadequately treated maternal syphilis. CS is more likely with early stages of maternal syphilis, but most mothers lack signs or symptoms and the risk of CS is unclear. GOAL: The goal of this study was to evaluate Treponema pallidum IgM Western blot (TP IgM WB) and a T. pallidum IgM enzyme immunoassay (TP IgM ELISA) in mothers with syphilis to determine if positive tests better indicate a risk of CS than a rapid plasma reagin titer >/=1:16. STUDY DESIGN: Ninety-seven mother-baby pairs with reactive syphilis serology were evaluated. RESULTS: TP IgM WB tests were positive in 18 pregnancies (7 of 18 babies had CS) and negative in 79 pregnancies (7 of 82 babies had CS). Thirty-two mothers had titers >/=1:16 (6 babies with CS) and 65 mothers had titers </=1:8 (8 babies with CS). CONCLUSION: TP IgM tests better identify mothers at risk of delivering babies with CS than maternal titer >/=1:16.

Adult↗
PubMed1990

The effects of case definition in maternal screening and reporting criteria on rates of congenital syphilis.

Reports of congenital syphilis in 1987 were reviewed to determine how new national guidelines for defining congenital syphilis would influence reported rates in Los Angeles County. After reviewing all reported reactive serologic tests for syphilis, we found 166 additional cases, resulting in a 426 percent increase in the 1987 reported rate of congenital syphilis. Rates of congenital syphilis are dependent upon surveillance practices, screening policies, and case definition.

Female↗
PubMedDate not supplied

Acquired syphilis in a patient with late congenital syphilis.

Late congenital syphilis was diagnosed in a 22-year-old woman on the basis of clinical, serologic and epidemiologic features. Clinical examination showed the "saddle-nose" deformity, Hutchinson's teeth, high-arched palate, Dubois little-finger sign, and small maxillae resulting in shallow depression of the central part of the face. Two years after receiving adequate treatment for late congenital syphilis, she presented with a primary syphilitic chancre; thus it was concluded that the woman had no immunity to reinfection with Treponema pallidum.

Adult↗
PubMed2004

Congenital syphilis in a Nairobi maternity hospital.

OBJECTIVE: To assess adverse pregnancy outcome associated with maternal syphilis and congenital syphilis rate based on FTA-ABS-19s-IgM. DESIGN: Descriptive cross-sectional study. SETTING: Pumwani Maternity Hospital (PMH), the largest maternity unit in Nairobi, Kenya. SUBJECTS: Rapid Plasma Reagin reactive women and their live born infants. MAIN OUTCOME MEASURES: Syphilis serology in pregnant women, FTA-ABS-19s-IgM in cord blood and pregnancy outcome. RESULTS: Three hundred and seventy seven out of 12,414 women (3%) were RPR+. 4.0% of RPR+ and 1.4% of RPR- women delivered a stillbirth (OR 3.0, p<0.001). 19% of RPR+ and 10% of RPR- had low birth weight deliveries (OR 2.1, p<0.001). Mothers untreated for syphilis during pregnancy had significantly more preterm births (18.5% vs 9.2%, OR 2.3, p=0.026), and more stillbirths (5.4% vs 1.0%, OR 6.3, p=0.044). Of the 200 randomly selected cord bloods of RPR+ women, 142 (72%) were TPHA+. Nine (6.3%) of the 142 TPHA+ cords were FTA-ABS-19s-IgM+. CONCLUSIONS: Stillbirth and low birth weight rates were high in RPR+ untreated pregnant women and treatment significantly improved pregnancy outcome. Based on very stringent laboratory criteria (FTA-ABS-19s-IgM), 6.3% of live born infants with TPHA+ cord blood were considered syphilis infected.

Cross-Sectional Studies↗
PubMed2005

Premature loss of primary teeth associated with congenital syphilis: a case report.

Congenital syphilis is an infectious disease transmitted by an infected mother to her fetus. Several reports in the literature have focused on oral manifestations of congenital syphilis, mainly about Hutchinson's teeth and dysplastic molars, which are more common. However, this paper describes an unusual feature of congenital syphilis in a four-year-old child. A case of premature loss of primary teeth associated with congenital syphilis is reported.

Alveolar Bone Loss↗
PubMed2003

[Curable dementia revealing late congenital syphilis].

UNLABELLED: Late congenital syphilis is a rare disease and its neurological expression is exceptional. We report a case revealed by a curable dementia. CASE REPORT: This 17-year-old patient presented for one year progressive dementia, frontal syndrome and extra pyramidal syndrome. The cerebral CT scan showed a diffuse cortical and subcortical atrophy. Blood and CSF positive antibodies confirmed the diagnosis of late congenital meningoencephalitis due to syphilis. The outcome after 13 months follow-up was favourable with penicillin therapy. COMMENTS: Late congenital syphilis is a rare disease, that may be exceptionally revealed by a curable dementia. Evolution may be favourable with early penicillin therapy.

Adolescent↗
PubMed1990

Immune studies in infants with congenital syphilis.

Seventeen neonates with congenital syphilis were studied to determine the immune response of the fetus following intra-uterine infection with Treponema pallidum. The results were compared with those from healthy controls matched for gestational age, birth weight and sex. B cells, IgM, and circulating immune complexes were significantly elevated in the infected newborns. There were no differences in lymphocyte transformation to phytohaemagglutinin (PHA) and in the CD3, CD4, and CD8 lymphocytes between infants with congenital syphilis and controls. Newborns with congenital syphilis have a heightened humoral response but no quantitative abnormality in cell-mediated immunity. Speculation on the role of the circulating immune complexes is presented.

Antigen-Antibody Complex↗
PubMed2006

Epidemiology of syphilis in pregnant women and congenital syphilis in Belarus.

In Belarus the spread of syphilis has been on the increase since 1988, and the incidence reached its peak in 1996 with 209.7 cases per 100 000 inhabitants. During the following years the incidence has reduced, but still remains high with 41 cases in 2004. In the years 1996-2004 all together 4239 pregnant women infected with syphilis were registered in Dermatovenereological Dispensaries in Belarus, giving birth to 116 children with congenital syphilis. The social end economic background of these events is reviewed.

Adolescent↗
PubMed1995

Postneonatal screening for congenital syphilis.

The incidence of congenital syphilis has recently reached epidemic proportions. With the resurgence of this important clinical entity, currently recommended screening procedures may be inadequate. We describe three cases that highlight the limitations of these screening procedures. All these infants had associated maternal risk factors for congenital syphilis, such as poor prenatal care and illicit drug use. All the infants and mothers were seronegative for syphilis at the time of birth but the infants became seropositive at 2 months of age. These cases support the need to reexamine current screening policies. In addition to prenatal and at-delivery screenings for congenital syphilis, it may be appropriate to screen infants born to high-risk mothers at 4 to 8 weeks of age.

District of Columbia↗
PubMed2002

Treatment of syphilis in pregnancy and prevention of congenital syphilis.

Studies about the management of syphilis during pregnancy were reviewed. They lacked uniformity in diagnostic criteria and study design. Currently recommended doses of benzathine penicillin G are effective in preventing congenital syphilis in most settings, although studies are needed regarding increased dosing regimens. Azithromycin and ceftriaxone offer potential alternatives for penicillin-allergic women, but insufficient data on efficacy limit their use in pregnancy. Ultrasonography provides a noninvasive means to examine pregnant women for signs of fetal syphilis, and abnormal findings indicate a risk for obstetric complications and fetal treatment failure. Ultrasonography should precede antepartum treatment during the latter half of pregnancy to gauge severity of fetal infection. However, optimal management of the affected fetus has not been established; collaborative management with a specialist is recommended. Antepartum screening remains a critical component of congenital syphilis prevention, even in the era of syphilis elimination.

Female↗
PubMed1994

Analysis of western blotting (immunoblotting) technique in diagnosis of congenital syphilis.

The diagnosis of congenital syphilis in apparently healthy infants continues to be problematic. Immunoglobulin M antibodies specific for a subset of Treponema pallidum antigens have been detected by Western blotting (immunoblotting). In the present study we investigated the sensitivity and specificity of this method. We tested 26 infants aged 0 to 4 months who fulfilled the accepted criteria for the diagnosis of congenital syphilis. There were 14 symptomatic infants. Sera from 13 of these infants were positive for the 47-kDa treponemal antigen (92% sensitivity). The remaining 12 infants were clinically asymptomatic when tested at birth but subsequently displayed features consistent with the disease. Reactive blots (antibodies to the 47- and/or the 15-kDa antigens) were noted in 10 of the 12 infants (83% sensitivity). Thirty infants whose mothers had syphilis were monitored and shown to be uninfected. Nonreactive blots were seen in sera from 27 infants, while sera from 3 older infants had false-positive tests (90% specificity). The Western blotting technique is sensitive (even in the diagnosis of clinically inapparent cases) and, in the absence of immunoglobulin M rheumatoid factor, is a useful confirmatory test for congenital syphilis.

Antibodies, Bacterial↗
PubMedDate not supplied

[Congenital syphilis: update and perspectives].

Congenital syphilis is responsible for a variety of clinical symptoms, from subclinical attacks to septicemic forms that may be fatal. The most frequently encountered forms typically involve low birth weight, heptosplenomegaly and jaundice. Premature birth, anemia, cutaneous lesions, coryza, anasarca and pseudoparalysis may also occur. Neonatal X rays generally show characteristic but nonspecific osteochondrocyte lesions and periosteous dystrophy. A clinical form partly associated with growing tissues may be detected late. Diagnosis of fetal syphilis depends on the detection by immunofluorescence of specific IgM immunoglobulins in the newborn. Parenteral antibiotic treatment with 100,000 IU penicillin/kg.day for 15 days is given to newborns with symptoms. The classification and treatment of asymptomatic forms is unclear. A single injection of benzathine-penicillin is a good compromise between simple surveillance and admission to hospital for 10 days of intravenous treatment. In any case, serological surveillance is required to check that IgM disappears from the blood or that the titer of IgG decreases. Reinfection is always possible, even in a newborn treated correctly. In developing countries, pediatricians must be aware of the various clinical forms of congenital syphilis. In addition, national programs to combat sexually transmitted diseases should be supported and developed by international aid agencies. In economically advanced countries, attention is currently focused on the restricted nature of medical treatment. Improvements in the management of congenital syphilis depend above all on dealing with the social and cultural problems of populations affected by syphilis.

Adult↗
PubMedDate not supplied

The cost of a preventable disease: estimated U.S. national medical expenditures for congenital syphilis, 1990.

Reported cases of congenital syphilis have increased rapidly in recent years. The purpose of this study was to estimate first-year medical care expenditures among 1990 incident cases of infants diagnosed with congenital syphilis. The authors used a synthetic estimation model to calculate expenditures for congenital syphilis as the number of treated cases multiplied by cost per case. The number of cases was derived from surveillance data adjusted for underreporting and presumptive (false-positive) treatment. Cost per case was based on expected hospital and physician charges applied to case treatment protocols appropriate to case severity. Base-case estimated first-year medical expenditure for 1990 treated cases (N = 4,400) in 1990 was +12.5 million. In sensitivity analysis, estimates ranged from +6.2 million to +47 million. Substantial reduction in congenital syphilis treatment costs could be achieved through targeted public health interventions consisting of prenatal maternal screening and contact tracing of males testing positive for syphilis. Physicians should be aggressive in presumptive treatment of newborns, since this usually prevents future disability but represents a small portion of total national expenditure for congenital syphilis. More precise data on severe cases resulting in long-term disability are needed to make reliable cost estimates.

Female↗
PubMed1995

Maternal syphilis in Michigan: the challenge to prevent congenital syphilis.

Syphilis has re-emerged as a significant public health problem for pregnant women and their babies in Michigan, US, and in many areas of the world. In the US over 50,000 cases of primary and secondary syphilis were reported to the Centers for Disease Control (CDC) in 1990. Due to the current epidemic of maternal syphilis in pregnancy in our city, we studied 253 cases of maternal syphilis over a one-year period. Our objective was to determine maternal risk factors during pregnancy predicting congenital infection. Women with high venereal disease research laboratory (VDRL) titres during pregnancy and unknown duration of disease had the highest incidence of delivering an infant with congenital syphilis. Even with treatment according to the current CDC guidelines there was a 27% incidence of congenital syphilis if disease duration was < 1 year and a 49% incidence of congenital syphilis for unknown duration of disease. Maternal syphilis during pregnancy was associated with significant neonatal morbidity and a preterm delivery incidence of 28%. The clinical evaluation, management, and current treatment guidelines are reviewed in this paper.

Female↗
PubMed1985

[Early congenital syphilis: apropos of 5 cases].

Congenital syphilis has in large part disappeared in countries where antiveneral legislations and preventive measures are well developed. In France, although there is no declaration of congenital syphilis between 1971 and 1983 in the official statistics of the Paris region, congenital syphilis is nevertheless mentioned as sporadic cases. The authors report here five cases of precocious congenital syphilis collected from august 1981 to december 1982 by a department of antiveneral consultations in the Paris region.

Doxycycline↗