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[Congenital syphilis, generalities].
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[Epiphyseal growth in congenital syphilis].
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Second infection in treated and untreated congenital syphilis.
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Prenatal and congenital syphilis in British Columbia.
OBJECTIVE: To describe the incidence of maternal syphilis and the corresponding rate of infection in exposed neonates in British Columbia before and after a serious outbreak of infectious syphilis in the heterosexual population. METHODS: We conducted a retrospective chart review of pregnant women with positive syphilis serology and reported cases of congenital syphilis in British Columbia from 1994 to 2003. Clinical charts were reviewed for demographic information, staging of maternal syphilis, and stage of pregnancy when treatment was received. The primary outcome measure was the number of cases of congenital syphilis. We conducted a 2-sided z-test and Fisher's exact test to determine differences in the proportion of infectious syphilis in mothers and the number of cases of congenital syphilis before and during the major outbreak. RESULTS: In 389 478 live births in British Columbia between 1994 and 2003, 77% of mothers had prenatal syphilis serology. A diagnosis of syphilis was made in 183 mothers, resulting in 5 cases of congenital syphilis. Four of these were in infants whose mothers did not undergo prenatal syphilis testing. The proportion of pregnant women with infectious syphilis was significantly higher after the onset of a major outbreak of syphilis in the community than it was before (P = 0.001), but there was no significant difference in the number of cases of congenital syphilis (3 before and 2 after the outbreak, P = 0.36). CONCLUSION: Although syphilis rates in British Columbia during the study period rose steadily, the prevalence of congenital syphilis remained low. Our findings suggest that, in the context of a major outbreak, universal screening and prenatal syphilis testing may contribute to controlling rates of congenital syphilis.
The unusual case: persistence of metaphyseal changes in penicillin treated congenital syphilis.
A case of congenital syphilis is described in which the diagnosis was not made until the age of 9 and with persistance of metaphyseal changes in spite of prolonged penicillin treatment.
Skeletal scintigraphy in congenital syphilis.
Two infants with congenital syphilis are described. Both had bone scans, the one showing significant changes in a focal lesion, while the other was unremarkable. Radiographic changes were evident at the time of the scan in the second infant, but only became apparent later in the first case. The possible cause for this discrepancy is discussed.
Congenital syphilis--United States, 1998.
Congenital syphilis (CS) occurs when the spirochete Treponema pallidum is transmitted from a pregnant woman with syphilis to her fetus. A multiorgan infection, CS may result in a neurologic or musculoskeletal handicap or death in the fetus when not properly treated. Trends in CS rates in women of childbearing age follow by approximately 1 year the rates of primary and secondary syphilis. The last national syphilis epidemic, which was followed by a CS epidemic, occurred during the late 1980s and early 1990s. The syphilis rate began to decline in 1991; the CS rate began to decline in 1992. To evaluate CS epidemiology since this decline, CDC analyzed 1998 CS notifiable disease data and assessed rate changes during 1992-1998. This report summarizes the results, which indicate that the CS rate declined 78.2% from 1992 to 1998, and that rates remained disproportionately high in the southeastern United States and among minority racial/ethnic populations.
Congenital syphilis--United States, 2002.
Congenital syphilis (CS) occurs when the spirochete Treponema pallidum is transmitted from a pregnant woman with syphilis to her fetus. Untreated syphilis during pregnancy can lead to stillbirth, neonatal death, or infant disorders such as deafness, neurologic impairment, and bone deformities. This report summarizes 2002 CS surveillance data, which indicated that CS rates have decreased among all racial/ethnic minority populations and in all regions of the United States except the Northeast. To further decrease CS, collaborative efforts among health-care providers, health insurers, policymakers, and the public are needed to increase prenatal care and syphilis screening during pregnancy for women at risk for delivering infants with CS.
Membranous glomerulonephritis in congenital syphilis.
The glomerulonephritis of congenital syphilis is thought to be immune-complex mediated. We describe a case of C. S. in whom the only manifestation was a glomerulonephritis. Immunopathogenic studies allowed the identification of treponemal antigen in glomeruli. The elution of immunoglobulins from renal tissue showed that glomerular deposits contained antitreponemal antibodies. Cryoglobulins with antitreponemal activity were also isolated from the patient's serum.
Congenital syphilis in the Russian Federation: magnitude, determinants, and consequences.
OBJECTIVES: Reported cases of congenital syphilis in the Russian Federation increased 26-fold from 1991-9. Our objectives were to describe the frequency, risk factors, and consequences of delivering an infant with congenital syphilis among pregnant women with active syphilis. METHODS: In a retrospective record review using consecutive sampling of logs at maternity hospitals in five geographic areas, data were abstracted for 850 women with active syphilis during pregnancy who had completed >/=20 weeks' gestation. Further information was abstracted from records in antenatal clinics, dermatovenereology clinics, and paediatric hospitals. We assessed the frequency of confirmed or probable congenital syphilis, used logistic modelling to identify independent predictors for delivering a baby with congenital syphilis, and calculated the proportion of infants with congenital syphilis who experienced late fetal death (20-27 weeks), stillbirth (>/=28 weeks), or infant death. RESULTS: A total of 64% (n=544) of 850 pregnant syphilis infected women delivered an infant with confirmed or probable congenital syphilis; 40% of the sample had no prenatal care. Among women with no prenatal care, 77% received either no treatment or inadequate treatment and 86% delivered an infant with congenital syphilis. Important independent and modifiable risk factors for delivery of an infant with congenital syphilis included receiving no prenatal care (adjusted OR 2.8, 95% CI 1.7 to 4.7) and having the first test for syphilis at >/=28 weeks' gestation (adjusted OR 4.0, 95% CI 2.6 to 6.0). Fatal outcomes were observed in 26% of infants with congenital syphilis, including late fetal death (7%), stillbirth (16%), or neonatal death (3%). CONCLUSIONS: In the Russian Federation, the frequency of congenital syphilis is high, risk factors for congenital syphilis are modifiable, and the consequences of congenital syphilis are severe.
A case of early congenital syphilis.
A case of early congenital syphilis is reported in order to emphasize that syphilis is still present nowadays and that detection of syphilis in pregnant women is primordial for the prevention of this disease.
Umbilical cord sclerosis as an indicator of congenital syphilis.
In two cases of congenital syphilis examination of the umbilical cord showed a distinctive picture of perivascular sclerosis and inflammation. Large numbers of spirochaetes were shown in the sclerotic zone in both cases. No organisms were demonstrable in the placental disc and there were no morphological changes suggestive of syphilis. It is concluded that the finding of sclerosing funisitis, together with the clinical circumstances, should raise the possibility of congenital syphilis.
Characteristics of mothers of live infants with congenital syphilis in Florida, 1987-1989.
The incidence of congenital syphilis in Florida increased sixfold from 1985 through 1989, and more than 80% of the cases occurred in metropolitan areas of southern Florida. To characterize the population of pregnant women in Florida at high risk of delivering an infant with congenital syphilis, the authors conducted a case-control study using birth certificates. Birth certificates were obtained for 256 of the 344 live infants reported as having congenital syphilis from 1987 through 1989 (74%); the 246 of these infants born in hospitals were matched for hospital and week of birth with an equal number of controls. In conditional multiple logistic regression, the following maternal characteristics were independent risk factors for congenital syphilis: young age, black race, single marital status, absence of a father's name on the birth certificate, previous pregnancy, substance abuse, and lack of prenatal care. Although the national origin of the mother was not a significant risk factor, the infants of black mothers born in the United States were at greater risk than the infants of black mothers born outside the United States. Mothers who had < or = 3 prenatal visits had an increased risk of delivering an infant with congenital syphilis as compared with mothers who had > 3 visits. This study suggests that targeted outreach efforts are necessary to control congenital syphilis and provides guidance for public health intervention activities.
ACQUIRED SYPHILIS IN A PATIENT WITH CONGENITAL SYPHILIS.
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Congenital syphilis revisited.
Despite decades of experience with congenital syphilis, problems still arise in case definition, diagnostic evaluation, treatment, and follow-up. We reviewed all 50 cases of early congenital syphilis reported to the State of Texas in 1982. A large proportion of the infants were premature (39%), of low birth weight (38%), and symptomatic at birth (62%). Because of these findings, we believe that possible cases of asymptomatic congenital syphilis in Texas may be under-reported. Laboratory and/or roentgenographic findings were important to confirm the diagnosis of congenital syphilis. Over half of the asymptomatic infants had positive results of cerebrospinal fluid VDRLs. After diagnosis, the treatment of infants with penicillin varied considerably. While all 47 living infants were treated with penicillin, 21 different regimens were used. We urge all physicians to perform complete diagnostic evaluations on suspected infants consisting of a quantitative serum test for syphilis, serum IgM levels, a cerebrospinal fluid VDRL, roentgenographs of the long bones, and dark-field microscopy where indicated. Additionally, infants and their families need appropriate follow-up after treatment.
Diagnosis of congenital syphilis by combining Treponema pallidum-specific IgM detection with immunofluorescent antigen detection for T. pallidum.
Most infants at risk for congenital syphilis can be identified easily by a positive maternal serologic test for syphilis. However, a diagnosis of congenital syphilis can be difficult to make in an individual infant. Seven infants with delayed-onset congenital syphilis and 101 newborns at risk for congenital syphilis were evaluated for characteristic physical findings and laboratory-detectable abnormalities of congenital syphilis. By using a combination of Western blot for T. pallidum-specific IgM detection and immunofluorescent antigen detection for the identification of T. pallidum, a diagnosis of congenital syphilis was made in all 7 infants with delayed-onset congenital syphilis and 24 of the 101 newborns at risk for congenital syphilis. However, T. pallidum-specific IgM was negative in 6 of the 24 newborns with congenital syphilis. T. pallidum-specific IgM detection alone is inadequate for the diagnosis of congenital syphilis.
Intestinal obstruction in the newborn with congenital syphilis.
Four newborn patients with congenital syphilis and intestinal obstruction are discussed in this report. In three cases, the obstruction was due to inspissated meconium, simulating the features of meconium ileus in one, meconium plug in the second, and associated with perforation of the terminal ileum in the third. An exocrine pancreatic insufficiency and a motility disturbance of the intestine due to syphilitic infection during fetal life could be the probable etiologic factor. The fourth patient had multiple ileal stenoses. Ischemia due to the prenatal syphilitic arteritis of the bowel wall can be responsible for this pathology. Attention is drawn to the association between congenital syphilis and neonatal intestinal obstruction.