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Hufstetler K, Llata E, Miele K, Quilter LAS. Clinical Updates in Sexually Transmitted Infections, 2024. J Womens Health (Larchmt) 2024; 33:827-837. [PMID: 38770770 DOI: 10.1089/jwh.2024.0367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Sexually transmitted infections (STIs) continue to increase in the United States with more than 2.5 million cases of gonorrhea, chlamydia, and syphilis reported to the Centers for Disease Control and Prevention in 2022. Untreated STIs in women can lead to adverse outcomes, including pelvic inflammatory disease, infertility, chronic pelvic pain, and pregnancy complications such as ectopic pregnancy, early pregnancy loss, stillbirth, and neonatal transmission. STI-related guidelines can be complex and are frequently updated, making it challenging to stay informed on current guidance. This article provides high-yield updates to support clinicians managing STIs by highlighting changes in screening, diagnosis, and treatment. One important topic includes new guidance on syphilis screening, including a clarified description of high community rates of syphilis based on Healthy People 2030 goals, defined as a case rate of primary or secondary syphilis > 4.6 per 100,000. Reproductive aged persons living in counties above this threshold should be offered syphilis screening. Additionally, American College of Obstetricians & Gynecologists now recommends syphilis screening three times during pregnancy regardless of risk-at the first prenatal visit, during the third trimester, and at delivery. In addition, new guidance to support consideration for extragenital screening for gonorrhea and chlamydia in women at sites such as the anus and pharynx is discussed. Other topics include the most recent chlamydia, gonorrhea, trichomoniasis, and pelvic inflammatory disease treatment recommendations; screening and treatment guidance for Mycoplasma genitalium; genital herpes screening indications and current diagnostic challenges; and the diagnosis and management of mpox in women and during pregnancy.
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Affiliation(s)
- Kaitlin Hufstetler
- CDC Foundation, Atlanta, Georgia, USA
- Division of STD Prevention; National Center for HIV, Viral Hepatitis, STD, and TB Prevention; Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eloisa Llata
- Division of STD Prevention; National Center for HIV, Viral Hepatitis, STD, and TB Prevention; Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathryn Miele
- Division of STD Prevention; National Center for HIV, Viral Hepatitis, STD, and TB Prevention; Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laura A S Quilter
- Division of STD Prevention; National Center for HIV, Viral Hepatitis, STD, and TB Prevention; Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Scherler G, Tomaske M, Cannizzaro V, Steppacher A, Zucol F, Theiler M, Toutous Trellu L, Labutin A, Bosshard PP, Berger C, Meyer Sauteur PM. Congenital syphilis in Switzerland: a retrospective cohort study, 2010 to 2019. Swiss Med Wkly 2023; 153:40121. [PMID: 37988348 DOI: 10.57187/smw.2023.40121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
AIMS OF THE STUDY We previously reported a re-emergence of syphilis from 2006 to 2009 with detection of congenital syphilis in Switzerland. This study aimed to reassess the incidence of children exposed to maternal syphilis during pregnancy and congenital syphilis in a following 10-year period in the canton of Zurich, the most populous canton in Switzerland with the highest incidences of syphilis. METHODS Children were identified both by reviewing medical records at the four major neonatal and paediatric hospitals providing acute care in the canton of Zurich and by the serological database of the syphilis reference laboratory. Inclusion criteria for children were (a) date of birth in the period 2010-2019, (b) place of birth in the canton of Zurich, (c) evaluation for syphilis due to positive syphilis pregnancy screening and (d) age <1 year at diagnosis. Results were compared with epidemiological data provided by the Federal Office of Public Health (FOPH). RESULTS We identified and evaluated 17 children after potential exposure to maternal syphilis. Residual antibodies of a past infection were found in 11 mothers. Six children were identified as having had real exposure to asymptomatic maternal syphilis. From an epidemiological perspective, the distribution of the cases followed a similar pattern as confirmed syphilis cases in women of childbearing age reported to the FOPH. No cases of congenital syphilis were observed. CONCLUSIONS In contrast to the rise in syphilis infections, this study identified no cases of congenital syphilis in the canton of Zurich, Switzerland, in the period 2010-2019. Syphilis pregnancy screening may have prevented congenital syphilis by diagnosing and allowing adequate treatment of asymptomatic maternal syphilis.
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Affiliation(s)
- Gioia Scherler
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Maren Tomaske
- Department of Paediatrics, Triemli Hospital Zurich, Zurich, Switzerland
| | - Vincenzo Cannizzaro
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anna Steppacher
- Department of Paediatrics, Triemli Hospital Zurich, Zurich, Switzerland
| | - Franziska Zucol
- Paediatric Infectious Diseases, Department of Paediatrics, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Martin Theiler
- Paediatric Skin Centre, Department of Dermatology, University Children's Hospital Zurich, Zurich, Switzerland
| | | | | | - Philipp P Bosshard
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Patrick M Meyer Sauteur
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
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3
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Aires Figueiredo L, Botelho Brito T, Labrusco M, Brigham Figueiredo M, Lopo Tuna M. A Rare But Pathognomonic Sign of Congenital Syphilis. J Pediatr 2023; 262:113622. [PMID: 37473989 DOI: 10.1016/j.jpeds.2023.113622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Leonor Aires Figueiredo
- Neonatal Intensive Care Unit, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; Department of Pediatrics, Hospital do Espírito Santo, Évora, Portugal
| | - Teresa Botelho Brito
- Neonatal Intensive Care Unit, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; Department of Pediatrics, Hospital de São Bernardo, Setúbal, Portugal
| | - Miguel Labrusco
- Neonatal Intensive Care Unit, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; Department of Pediatrics, Hospital Beatriz Ângelo, Loures, Portugal
| | | | - Madalena Lopo Tuna
- Neonatal Intensive Care Unit, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; CHRC, NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
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Soares JAS, Holzmann APF, Alves BBDS, Lima CFQ, Caldeira AP. Congenital syphilis: associated factors in a follow-up outpatient clinic. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 41:e2022049. [PMID: 37255107 DOI: 10.1590/1984-0462/2023/41/2022049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/26/2022] [Indexed: 06/01/2023]
Abstract
OBJECTIVE This study aimed to describe the characteristics of mothers and children assisted in a follow-up clinic for congenital syphilis and identify the factors associated with the confirmation of the diagnosis. METHODS This is a prospective study conducted from 2016 to 2019 in Montes Claros, Northern Minas Gerais, Brazil. Specific forms addressing maternal sociodemographic, behavioral, and lifestyle habit characteristics, as well as characteristics related to access to healthcare, were used. Hierarchical Poisson regression analysis was performed to define the factors associated with diagnostic confirmation, including the calculation of the prevalence ratios (PR) and respective 95% confidence intervals (95%CI). RESULTS A total of 200 binomials (mother-child) who attended at least one appointment as part of the follow-up after discharge from the maternity hospital were eligible for the study. The mothers were mostly young (79.0%), with a low educational level (43.0%), and black (89.5%). Nearly half of the mothers reported not having a steady sexual partner (42.5%). About a quarter attended less than six prenatal appointments (27.5%). Nearly half did not treat the disease adequately during pregnancy (24.5%). The diagnosis of congenital syphilis was confirmed for 116 children. The following factors were associated with the diagnostic confirmation after multiple analyses: low maternal educational level (PR 1.30; 95%CI 1.05-1.60), maternal risky sexual behavior (PR 1.34; 95%CI 1.07-1.66), inadequate treatment of the mother (PR 3.16; 95%CI 2.42-4.47), and lack of treatment of the partner (PR 1.44; 95%CI 1,18-1.81). CONCLUSIONS Syphilis remains a major challenge. The results highlight the social inequities associated with congenital syphilis and the lack of proper management of pregnant women and their partners.
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Wolfson AR, Schatz MX. Management of the Pregnant Patient with Beta-Lactam Allergy. Curr Allergy Asthma Rep 2023; 23:189-194. [PMID: 36749447 DOI: 10.1007/s11882-023-01069-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW We review the literature and discuss the logistics of testing pregnant patients for penicillin allergy. RECENT FINDINGS As in the general population, pregnant patients commonly report a penicillin allergy, but most patients are able to tolerate penicillin. Avoidance of beta-lactams in pregnancy is associated with increased morbidity: longer hospitalizations, more frequent infections, and more complications. Penicillin allergy testing is safe in pregnant patients, and obstetricians are eager for allergists to offer this procedure to their patients. As allergists, we can improve our patients' health outcomes by offering penicillin allergy testing in our practices. The protocols for testing both with and without skin testing in pregnant patients have been studied, and future studies will continue to clarify the safety and efficacy of penicillin allergy delabeling in pregnant patients.
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Affiliation(s)
- Anna R Wolfson
- Harvard Medical School, Boston, MA, USA. .,Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
| | - Michael X Schatz
- Department of Allergy, Kaiser Permanente Medical Center, San Diego, CA, USA
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Follow-up of infants with congenital syphilis during the penicillin shortage period. J Pediatr (Rio J) 2022; 99:302-308. [PMID: 36584977 DOI: 10.1016/j.jped.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/24/2022] [Accepted: 11/29/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To analyze the follow-up, in specialized outpatient clinics, of infants reported with congenital syphilis during the penicillin shortage. METHOD A cross-sectional study was carried out in ten public maternity hospitals affiliated with the Brazilian Unified Health System in the city of Fortaleza, state of Ceará. Clinical records of infants reported with congenital syphilis who were born alive in 2015 were used to describe correlates of attendance at recommended clinical follow-up appointments. RESULTS A total of 469 infants reported with CS from January 1/2015 to December 31/2015 were included in the analysis. The results show that most infants did not attend the follow-up visits (368/469, 78.5%) and the main associated factors are that the follow-up clinic is located in a different hospital from that where the infant was born (OR: 3.7; CI: 2.20-6.22; p < 0.001) and the use of illicit drugs by the mother (OR: 3.2; CI: 1.57-6.87; p = 0.002). Only 33.7% (34/101) were followed until discharge. CONCLUSION The majority of infants with reported congenital syphilis during this period did not attend the follow-up visits. Public health efforts aimed at reaching the parents of infants with CS should be a priority to ensure appropriate clinical identification and management of the associated outcomes of this vertically transmitted infection.
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Ringoringo HP, Tambunan KR, Ananda FK, Nawati F, Permana YN. Amoxicillin as an Option in Congenital Syphilis Management: A Case Report. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Congenital syphilis (CS) is the second leading cause of preventable stillbirth globally. This case report shows that CS baby can be managed by amoxicillin with good results.
CASE PRESENTATION: A term female baby was born through section cesarean on suspicion of syphilis of a 29-year-old mother, G4P3A0, 39 weeks gestation with normal APGAR score, and birth weight was 2330 g, birth length was 46 cm, and head circumference 32 cm. There are no abnormalities on physical examination. The baby is active and clinically sound. In history taking, the mother was diagnosed with syphilis in the first trimester of pregnancy but did not want to be treated. After birth, maternal serology showed that Treponema pallidum is reactive. Maternal VDRL was reactive at 1:1, while TPHA was reactive at 1:2560. Baby laboratory results showed Hb 18.4 g/dL, leukocytes 33,480/μL, platelets 278,000/μL, and hematocrit 54.7%. A peripheral blood smear showed neutrophilia with hypersegmentation and monocytosis due to suspected chronic inflammation. Baby VDRL was reactive at 1:16, while TPHA was reactive at 1:1280. The diagnosis was congenital syphilis with low birth weight and small for gestational age. After one month of treatment with oral amoxicillin, baby VDRL was reactive at 1:2, while TPHA was reactive at 1:320. At 1½ months, the baby’s hemoglobin is 10.1 g/dL. X-rays for chest, abdomen, and skeletal were within normal limits. The baby was given oral amoxicillin 50 mg/kg/day for a total of 3 months. When the baby was 4 months old, her growth and development were good with the VDRL reactive 1:1 and the TPHA reactive 1:160.
CONCLUSION: In the unavailability of benzathine penicillin, amoxicillin may be considered an option in CS management.
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Wan Z, Tao Y, Zhang H, Hu Y, Shu K. Factors associated with congenital syphilis: A retrospective study in Jiangxi Province, China. Int J STD AIDS 2021; 33:156-163. [PMID: 34704494 DOI: 10.1177/09564624211052184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There are a lack of studies about factors influencing congenital syphilis (CS) in economically underdeveloped areas, such as Jiangxi Province, China. METHODS A retrospective study was conducted based on the information system of prevention of mother-to-child transmission of syphilis management in Jiangxi Province, China. Pregnant women with syphilis infection who delivered ≥28 gestational weeks and registered in this system from 1 January 2013 to 2030 June 2018 were enrolled. Maternal characteristics and treatment regimens associated with CS were evaluated using multivariable regression analysis. RESULTS 1196 syphilis infected mothers and their 1207 infants were included in the analyses, and 116 infants were diagnosed with CS, providing an overall incidence of 9.61% (116/1207). Multivariable logistic regression analysis showed that increasing maternal age was barely associated with the risk of CS (adjusted odds ratio (aOR) = 0.97, 95% CI, 0.93-1.00, p = .047). Women with a high nontreponemal serum test titer (≥1:8) had a 126% increased risk of delivering an infant with CS than those with a low titer (<1:8) (aOR = 2.26, 95% CI, 1.51-3.39, p < .001). The risk for CS decreased significantly in infants born to mothers receiving adequate treatment than those receiving no treatment (aOR = 0.36, 95% CI, 0.21-0.61, p < .001). CONCLUSIONS Adequate treatment is critical for the prevention of CS. Further strategies focusing on early diagnosis and adequate treatment among syphilis infected pregnant women, particularly among those with younger age and high nontreponemal titer, should be strengthened to prevent CS.
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Affiliation(s)
- Zhihua Wan
- Department of Health Care, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, China
| | - Yuling Tao
- Department of Health Care, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, China
| | - Huan Zhang
- Department of Health Care, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, China
| | - Yang Hu
- Department of Health Care, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, China
| | - Kuanyong Shu
- Department of Health Care, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, China
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9
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Kimball A, Bowen VB, Miele K, Weinstock H, Thorpe P, Bachmann L, McDonald R, Machefsky A, Torrone E. Congenital Syphilis Diagnosed Beyond the Neonatal Period in the United States: 2014-2018. Pediatrics 2021; 148:peds.2020-049080. [PMID: 34465590 PMCID: PMC8787842 DOI: 10.1542/peds.2020-049080] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES During 2014-2018, reported congenital syphilis (CS) cases in the United States increased 183%, from 462 to 1306 cases. We reviewed infants diagnosed with CS beyond the neonatal period (>28 days) during this time. METHODS We reviewed surveillance case report data for infants with CS delivered during 2014-2018 and identified those diagnosed beyond the neonatal period with reported signs or symptoms. We describe these infants and identify possible missed opportunities for earlier diagnoses. RESULTS Of the 3834 reported cases of CS delivered during 2014-2018, we identified 67 symptomatic infants diagnosed beyond the neonatal period. Among those with reported findings, 67% had physical examination findings of CS, 69% had abnormal long-bone radiographs consistent with CS, and 36% had reactive syphilis testing in the cerebrospinal fluid. The median serum nontreponemal titer was 1:256 (range: 1:1-1:2048). The median age at diagnosis was 67 days (range: 29-249 days). Among the 66 mothers included, 83% had prenatal care, 26% had a syphilis diagnosis during pregnancy or at delivery, and 42% were not diagnosed with syphilis until after delivery. Additionally, 24% had an initial negative test result and seroconverted during pregnancy. CONCLUSIONS Infants with CS continue to be undiagnosed at birth and present with symptoms after age 1 month. Pediatric providers can diagnose and treat infants with CS early by following guidelines, reviewing maternal records and confirming maternal syphilis status, advocating for maternal testing at delivery, and considering the diagnosis of CS, regardless of maternal history.
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Affiliation(s)
- Anne Kimball
- Division of Sexually Transmitted Diseases Prevention .,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Virginia B. Bowen
- Division of STD Prevention; Centers for Disease Control and Prevention; Atlanta, GA
| | - Kathryn Miele
- Division of STD Prevention; Centers for Disease Control and Prevention; Atlanta, GA,CDC Foundation; Atlanta, GA
| | - Hillard Weinstock
- Division of STD Prevention; Centers for Disease Control and Prevention; Atlanta, GA
| | - Phoebe Thorpe
- Division of STD Prevention; Centers for Disease Control and Prevention; Atlanta, GA
| | - Laura Bachmann
- Division of STD Prevention; Centers for Disease Control and Prevention; Atlanta, GA
| | - Robert McDonald
- Division of STD Prevention; Centers for Disease Control and Prevention; Atlanta, GA
| | - Aliza Machefsky
- Division of STD Prevention; Centers for Disease Control and Prevention; Atlanta, GA,CDC Foundation; Atlanta, GA
| | - Elizabeth Torrone
- Division of STD Prevention; Centers for Disease Control and Prevention; Atlanta, GA
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Wu M, Seel M, Britton S, Dean JA, Lazarou M, Safa H, Griffin P, Nourse C. Addressing the crisis of congenital syphilis: Key findings from an evaluation of the management of syphilis in pregnancy and the newborn in South-East Queensland. Aust N Z J Obstet Gynaecol 2021; 62:91-97. [PMID: 34463955 DOI: 10.1111/ajo.13424] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/20/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Syphilis in pregnancy and congenital syphilis (CS) are increasing in Australia. Prevention of adverse outcomes requires adherence to management guidelines. AIMS The aim is to evaluate the management of syphilis in pregnant women and their newborns. MATERIALS AND METHODS A retrospective study of public health notifications, clinical records and testing results of women with positive syphilis serology in pregnancy requiring treatment from 2016 to 2018 inclusive across South-East Queensland was conducted. Management was described and compared with contemporary guidelines from the Australasian Society of Infectious Diseases, the Communicable Diseases Network Australia and the United States Centers for Disease Control and Prevention. RESULTS Of 30 women identified, 22 (73%) had management consistent with the guidelines (stage-appropriate penicillin regimen, appropriate dosing interval and treatment completed greater than 30 days before delivery). Only 14 (47%) women had documentation of partner testing and/or treatment. Of 26 mother-infant pairs with complete data, 16 (62%) had investigations at delivery consistent with recommendations (parallel maternal-infant rapid plasma reagin, infant syphilis immunoglobulin M, placental histopathology +/- syphilis polymerase chain reaction and infant clinical examination). One infant met the criteria for confirmed CS. Five infants received penicillin therapy. Only seven (27%) infants had serological monitoring after discharge. CONCLUSIONS Management can be optimised with timely maternal testing and treatment, comprehensive partner screening and treatment, strict adherence to seven-day penicillin dosing for late latent syphilis and thorough maternal and infant testing after treatment and delivery. If maternal treatment was inadequate in pregnancy, consideration needs to be given to close evaluation and empiric treatment of the infant.
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Affiliation(s)
- Mandy Wu
- Queensland Children's Hospital, Brisbane, Australia.,School of Clinical Medicine, University of Queensland, Brisbane, Australia
| | - Mandy Seel
- Metro North Public Health Unit, Brisbane, Australia
| | - Sumudu Britton
- School of Clinical Medicine, University of Queensland, Brisbane, Australia.,Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Judith A Dean
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Mattea Lazarou
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Huda Safa
- Obstetrics and Gynaecology Department, Mater Mothers' Hospital, Brisbane, Australia
| | - Paul Griffin
- Infectious Diseases, Mater Mothers' Hospital, Brisbane, Australia
| | - Clare Nourse
- School of Clinical Medicine, University of Queensland, Brisbane, Australia.,Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, Australia
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Machefsky AM, Loosier PS, Cramer R, Bowen VB, Kersh EN, Tao G, Gift TL, Hogben M, Carry M, Ludovic JA, Thorpe P, Bachmann LH. A New Call to Action to Combat an Old Nemesis: Addressing Rising Congenital Syphilis Rates in the United States. J Womens Health (Larchmt) 2021; 30:920-926. [PMID: 34254848 DOI: 10.1089/jwh.2021.0282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Congenital syphilis (CS) is on the rise in the United States and is a growing public health concern. CS is an infection with Treponema pallidum in an infant or fetus, acquired via transplacental transmission when a pregnant woman has untreated or inadequately treated syphilis. Pregnant women with untreated syphilis are more likely to experience pregnancies complicated by stillbirth, prematurity, low birth weight, and early infant death, while their children can develop clinical manifestations of CS such as hepatosplenomegaly, bone abnormalities, developmental delays, and hearing loss. One of the ways CS can be prevented is by identifying and treating infected women during pregnancy with a benzathine penicillin G regimen that is both appropriate for the maternal stage of syphilis and initiated at least 30 days prior to delivery. In this article we discuss many of the challenges faced by both public health and healthcare systems with regards to this preventable infection, summarize missed opportunities for CS prevention, and provide practical solutions for future CS prevention strategies.
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Affiliation(s)
- Aliza M Machefsky
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Gilstrap Fellowship, CDC Foundation, Atlanta, Georgia, USA
| | - Penny S Loosier
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ryan Cramer
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Virginia B Bowen
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ellen N Kersh
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Guoyu Tao
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Thomas L Gift
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Matthew Hogben
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Monique Carry
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer A Ludovic
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Phoebe Thorpe
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laura H Bachmann
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Abstract
Maternal pathogens can be transmitted to the fetus resulting in congenital infection with sequelae ranging from asymptomatic infection to severe debilitating disease and still birth. The TORCH pneumonic (toxoplasmosis, rubella, cytomegalovirus, and herpes simplex virus) is used widely, but it provides a limited description of the expanding list of pathogens associated with congenital infection. This article focuses on the evaluation and management of infants with common congenital infections such as cytomegalovirus, and infections that warrant early diagnosis and treatment to prevent serious complications, such as toxoplasmosis, human immunodeficiency virus, and syphilis. Zika virus and Chagas disease remain uncommon.
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Affiliation(s)
- Amaran Moodley
- Department of Pediatrics, Rady Childrens Hospital & University of California San Diego, 3020 Children's Way, MC 5041, San Diego, CA 92123, USA
| | - Kurlen S E Payton
- David Geffen School of Medicine at University of California Los Angeles, Division of Neonatology, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, NT Suite 4221, Los Angeles, CA 90048, USA.
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13
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Rocha AFB, Araújo MAL, Barros VLD, Américo CF, Silva Júnior GBD. Complications, clinical manifestations of congenital syphilis, and aspects related to its prevention: an integrative review. Rev Bras Enferm 2021; 74:e20190318. [PMID: 34287560 DOI: 10.1590/0034-7167-2019-0318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 04/18/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to identify the scientific evidence about the clinical complications and manifestations of congenital syphilis and aspects related to its prevention. METHODS integrative review after a search in the databases LILACS and MEDLINE, carried out in March 2018, using the descriptors "syphilis, congenital", "complications", and "signs and symptoms", leading to the selection of 27 researches. RESULTS the publications found were published from 1966 to 2017, and most of them were from Latin America and Africa. Negative outcomes, laboratory changes, and the clinical manifestations in congenital syphilis, whether early or delayed, were, respectively: low weight at birth, anemia, hepatosplenomegaly, and dental alterations. The lack of treatment of the pregnant women in the prenatal was the most common occasion in which the opportunity to prevent the complications of congenital syphilis was lost. CONCLUSIONS the scientific evidences analyzed showed serious complications of congenital syphilis that could be avoided if early opportunities of diagnosing and treating the pregnant women are not lost during the prenatal.
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Congenital Syphilis Coinfection in a Preterm Infant with Early Onset Sepsis due to Enterobacter cloacae. Case Rep Infect Dis 2021; 2021:1334846. [PMID: 34336314 PMCID: PMC8286191 DOI: 10.1155/2021/1334846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/07/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Syphilis is a tropical disease, caused by a spirochete Treponema pallidum, which can be transmitted transplacentally from untreated mothers to the fetus during any stages of pregnancy. Clinical manifestations of early congenital syphilis are variable and nonspecific. The diagnosis is based on the serology status of the mother, newborn clinical symptoms, and comparative serology titer between mother and newborn. Case Presentation. A late preterm female infant, appropriate for gestational age, was treated for severe early onset sepsis due to Enterobacter cloacae since day 2 of life. The coinfection with Treponema pallidum was suspected and confirmed at day 4 with clinical signs and a fourfold increase of rapid plasma reagin (RPR) compared to mother's serology. Combined with meropenem and amikacin, Benzyl-Penicillin was used for 10 days, thereby resulting in a significant clinical and laboratory improvement. The girl was discharged at day 18 and brought for regular follow-ups for both growth milestone and syphilis serology. RPR decreased fourfold at the age of 1 month. Conclusion Syphilis should not be overlooked. The vertical transmission is preventable by an on-time treatment of the infected mother, triggered by a proper antenatal screening at the right time. Congenital syphilis should be ruled out in any challenging neonatal sepsis. The diagnosis tools and treatments are easily accessible and inexpensive in our economical settings.
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Saini AG, Kamila G, Vyas S. Severe microcephaly, intellectual disability and epilepsy: the ravages of congenital syphilis. BMJ Case Rep 2021; 14:14/6/e244203. [PMID: 34130983 DOI: 10.1136/bcr-2021-244203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Arushi Gahlot Saini
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gautam Kamila
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Vyas
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
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Domingues CSB, de Lannoy LH, Saraceni V, da Cunha ARC, Pereira GFM. Brazilian Protocol for Sexually Transmitted Infections 2020: epidemiological surveillance. Rev Soc Bras Med Trop 2021; 54:e2020549. [PMID: 34008715 PMCID: PMC8210489 DOI: 10.1590/0037-8682-549-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/10/2021] [Indexed: 11/22/2022] Open
Abstract
This article summarizes the chapter on epidemiological surveillance of sexually transmitted infections (STI) that comprises the 2020 Clinical Protocol and Therapeutic Guidelines (PCDT) for Comprehensive Care for People with STI, published by the Health Surveillance Department of the Brazilian Ministry of Health. It presents some reflections on the new case definitions for surveillance of acquired syphilis, syphilis in pregnant women, and congenital syphilis. The 2020 PCDT-IST was elaborated grounded on scientific evidence and validated in discussions with specialists. Epidemiological and clinical aspects are addressed, and health service managers' guidelines regarding programmatic and operational management of these diseases are presented. Guidelines for health professionals on screening, diagnosing, and treating people with STI and their sex partners, in addition to strategies for surveillance, prevention, and control actions, are also published. sexually transmitted infections are among the most common diseases in the world. They affect people's health and life, impact reproductive and child health, contribute to infertility and complications during pregnancy and birth.
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Affiliation(s)
- Carmen Silvia Bruniera Domingues
- Secretaria de Estado da Saúde de São Paulo, Centro de Referência e Treinamento de Doenças Sexualmente Transmissíveis e Aids, São Paulo, SP, Brazil
| | | | - Valeria Saraceni
- Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Gerson Fernando Mendes Pereira
- Secretaria de Estado da Saúde de São Paulo, Centro de Referência e Treinamento de Doenças Sexualmente Transmissíveis e Aids, São Paulo, SP, Brazil
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17
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Domingues CSB, Duarte G, Passos MRL, Sztajnbok DCDN, Menezes MLB. Brazilian Protocol for Sexually Transmitted Infections, 2020: congenital syphilis and child exposed to syphilis. Rev Soc Bras Med Trop 2021; 54:e2020597. [PMID: 34008719 PMCID: PMC8210493 DOI: 10.1590/0037-8682-597-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/10/2021] [Indexed: 11/22/2022] Open
Abstract
The topics of congenital syphilis and children exposed to syphilis compose the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Such document was elaborated based on scientific evidence and validated in discussions with specialists. This article provides guidelines for syphilis in pregnant women and congenital syphilis clinical management, emphasizing the vertical transmission of Treponema pallidum prevention. Epidemiological and clinical aspects of these infections are presented and recommendations for managers in the programmatic and operational management of syphilis. The article also includes guidelines for health professionals in screening, diagnosing, and treating people with sexually transmitted infections and their sex partners, in addition to strategies for surveillance actions, prevention, and control of the disease. Most congenital syphilis cases arise from test failures in prenatal care or inadequate or no treatment of maternal syphilis.
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Affiliation(s)
- Carmen Silvia Bruniera Domingues
- Secretaria de Estado da Saúde de São Paulo, Centro de Referência e Treinamento de Doenças Sexualmente Transmissíveis e Aids, São Paulo, SP, Brazil
| | - Geraldo Duarte
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Mauro Romero Leal Passos
- Universidade Federal Fluminense, Departamento de Microbiologia e Parasitologia, Niterói, RJ, Brazil
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18
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Rocha AFB, Araújo MAL, Taylor MM, Kara EO, Broutet NJN. Treatment administered to newborns with congenital syphilis during a penicillin shortage in 2015, Fortaleza, Brazil. BMC Pediatr 2021; 21:166. [PMID: 33832443 PMCID: PMC8028238 DOI: 10.1186/s12887-021-02619-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 03/21/2021] [Indexed: 11/23/2022] Open
Abstract
Background Between 2014 and 2016, Brazil experienced a severe shortage in penicillin supply, resulting in a lack of treatment among some pregnant women and newborns with syphilis and the use of non-evidence-based regimens. This study evaluated all live births in Fortaleza reported with CS in 2015 in order to identify the different therapeutic regimens used in newborns during this period of penicillin shortage. Methods A retrospective cross-sectional study design was conducted using manually extracted data from medical chart review of maternal and infant cases delivered in 2015 from all public maternity hospitals in the city of Fortaleza. Data collection occurred from June 2017 to July 2018. Results A total of 575 congenital syphilis cases were reported to the municipality of Fortaleza during 2015 and 469 (81.5%) were analyzed. Of these, only 210 (44.8%) were treated with a nationally-recommended treatment. As alternative therapeutic options, ceftriaxone was used in 65 (13.8%), Cefazolin in 15 (3.2%) and the combination of more than one drug in 179 (38.2%). Newborns with serum VDRL titers ≥1:16 (p = 0.021), who had some clinical manifestation at birth (p = 0.003), who were born premature (p < 0.001), with low birth weight (p = 0.010), with jaundice indicative of the need for phototherapy (p = 0.019) and with hepatomegaly (p = 0.045) were more likely to be treated with penicillin according to national treatment guidelines compared to newborns treated with other regimens. Conclusion During the period of shortage of penicillin in Fortaleza, less than half of the infants reported with CS were treated with a nationally-recommended regimen, the remaining received treatment with medications available in the hospital of birth including drugs that are not part of nationally or internationally-recommended treatment recommendations.
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Affiliation(s)
- Ana Fátima Braga Rocha
- University of Fortaleza-UNIFOR, Av. Washington Soares, 1321, Edson Queiroz, Fortaleza, Ceará, CEP 60.811-905, Brazil.
| | - Maria Alix Leite Araújo
- University of Fortaleza-UNIFOR, Av. Washington Soares, 1321, Edson Queiroz, Fortaleza, Ceará, CEP 60.811-905, Brazil
| | - Melanie M Taylor
- World Health Organization, Department of Sexual Reproductive Health and Research, Geneva, Switzerland.,US Centers for Disease Control and Prevention, Division of Sexually Transmitted Disease Prevention, Atlanta, GA, USA
| | - Edna O Kara
- World Health Organization, Department of Sexual Reproductive Health and Research, Geneva, Switzerland
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19
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Liew ZQ, Ly V, Olson-Chen C. An old disease on the rise: new approaches to syphilis in pregnancy. Curr Opin Obstet Gynecol 2021; 33:78-85. [PMID: 33337615 DOI: 10.1097/gco.0000000000000683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Maternal and congenital syphilis infection is on the rise in the United States and worldwide. Without adequate testing or provider recognition of infection, treatment can be neglected resulting in significant perinatal morbidity and mortality. This review article discusses the epidemiology of T. pallidum, describes novel diagnostic tests, and considers the need to expand therapeutic options. RECENT FINDINGS A new chemiluminescence immunoassay for use in the reverse-sequence algorithm is more sensitive and specific in pregnant women than previously noted and is helpful for identifying pregnant women at highest risk for neonatal congenital syphilis. Point-of-care testing may be used to detect early syphilitic disease and provide same-day testing and treatment. Randomized control trials of oral cefixime for treatment of syphilis are paving the way for potential use in pregnant women. Penicillin skin testing, challenge, and desensitization in pregnancy can be done safely. SUMMARY Congenital syphilis is a preventable disease and treatable infection in the modern world, but we are still met with challenges in its eradication. We should proceed with advancing efficient laboratory testing, expanding medical therapy, and implementing public health measures to curb the rise of the disease.
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Affiliation(s)
- Zi-Qi Liew
- University of Rochester Medical Center, Department of Obstetrics and Gynecology, Rochester, NY
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20
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Domingues CSB, Duarte G, Passos MRL, Sztajnbok DCDN, Menezes MLB. [Brazilian Protocol for Sexually Transmitted Infections 2020: congenital syphilis and child exposed to syphilis]. ACTA ACUST UNITED AC 2021; 30:e2020597. [PMID: 33729402 DOI: 10.1590/s1679-4974202100005.esp1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/03/2020] [Indexed: 11/22/2022]
Abstract
The topics of congenital syphilis and children exposed to syphilis are part of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. The Protocol and Guidelines have been developed based on scientific evidence and validated in discussions with specialists. This article provides guidelines for clinical management of both syphilis in pregnant women and also congenital syphilis, emphasizing prevention of vertical transmission of Treponema pallidum. Epidemiological and clinical aspects of these infections are presented, as well as recommendations for health service managers regarding the programmatic and operational management of syphilis. The article also includes guidelines for health professionals on screening, diagnosing and treating people with sexually transmitted infections and their sex partners, in addition to strategies for syphilis surveillance, prevention and control actions.
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Affiliation(s)
- Carmen Silvia Bruniera Domingues
- Secretaria de Estado da Saúde de São Paulo, Centro de Referência e Treinamento de Doenças Sexualmente Transmissíveis e Aids, São Paulo, SP, Brasil
| | - Geraldo Duarte
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brasil
| | - Mauro Romero Leal Passos
- Universidade Federal Fluminense, Departamento de Microbiologia e Parasitologia, Niterói, RJ, Brasil
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21
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Domingues CSB, Lannoy LHD, Saraceni V, Cunha ARCD, Pereira GFM. [Brazilian Protocol for Sexually Transmitted Infections 2020: epidemiological surveillance]. ACTA ACUST UNITED AC 2021; 30:e2020549. [PMID: 33729398 DOI: 10.1590/s1679-4974202100002.esp1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/14/2020] [Indexed: 11/21/2022]
Abstract
This article summarizes the chapter on epidemiological surveillance of sexually transmitted infections (STI) that forms part of the Clinical Protocol and Treatment Guidelines (PDCT) for Comprehensive Care for People with STI 2020), published by the Health Surveillance Secretariat of the Ministry of Health of Brazil. It presents some reflections on the new case definitions for surveillance of acquired syphilis, syphilis in pregnant women and congenital syphilis. The PCDT-IST 2020 was developed based on scientific evidence and validated in discussions with specialists. Epidemiological and clinical aspects are addressed, as well as guidelines for health service managers regarding programmatic and operational management of these diseases, guidelines for health professionals on screening, diagnosing and treating people with STIs and their sex partners, in addition to strategies for surveillance, prevention and control actions.
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Affiliation(s)
- Carmen Silvia Bruniera Domingues
- Secretaria de Estado da Saúde de São Paulo, Centro de Referência e Treinamento de Doenças Sexualmente Transmissíveis e Aids, São Paulo, SP, Brasil
| | | | - Valeria Saraceni
- Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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22
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Goodarzi H, Wu TT, Wang J, Teng JM. Neonatal Dermatology: The Normal, the Common, and the Serious. Neoreviews 2021; 22:e40-e51. [PMID: 33386313 DOI: 10.1542/neo.22-1-e40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The objective of this review is to help practitioners of neonatal and pediatric medicine become more familiar with diagnosing and managing neonatal skin conditions. This article will discuss normal neonatal skin care and benign and common rashes, as well as some of the serious dermatologic conditions that require specialists for further evaluation and/or treatment.
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Affiliation(s)
- Heidi Goodarzi
- Department of Dermatology, Stanford University, Palo Alto, CA
| | - Tiffany T Wu
- Department of Dermatology, Stanford University, Palo Alto, CA
| | - Jami Wang
- Department of Dermatology, Stanford University, Palo Alto, CA
| | - Joyce M Teng
- Department of Dermatology, Stanford University, Palo Alto, CA
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23
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Silva TDC, Santos LJPDN, Arrais NMR, Balen SA. Development of infants presented with congenital syphilis in their first months of life. REVISTA CEFAC 2021. [DOI: 10.1590/1982-0216/20212369321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Mother's Knowledge on HIV, Syphilis, Rubella, and Associated Factors in Northern Tanzania: Implications for MTCT Elimination Strategies. Int J Pediatr 2020; 2020:7546954. [PMID: 32695189 PMCID: PMC7368220 DOI: 10.1155/2020/7546954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/05/2020] [Indexed: 11/17/2022] Open
Abstract
Background Infections transmitted from mother to child (MTCT) during pregnancy, childbirth, and breastfeeding contribute significantly to the high infant and childhood morbidity and mortality in sub-Saharan African countries. The most significant and preventable of these include HIV, syphilis, and rubella. To achieve elimination, mothers need to be aware of and to understand effective preventive measures against these infections. Lack of comprehensive knowledge on transmission and prevention of MTCT infections is one of the factors hindering achievement of the elimination goals for these infections. The aim of this study was to assess the knowledge of HIV, syphilis, rubella, and associated factors among mothers in the Kilimanjaro region of Tanzania. Methods We conducted a community-based cross-sectional study in three districts of the Kilimanjaro region from September to October 2016. The study involved mothers with children up to five years of age. Data collection involved the use of a questionnaire, administered by face-to-face interviews. Logistic regression analysis was used to assess predictors of mothers' knowledge on MTCT infections. Results A total of 618 mothers were recruited, with a mean age of 29.6 (SD 7.6) years. The overall knowledge on MTCT infections was low. The highest level of knowledge on MTCT infections was regarding HIV (89.2%). Fewer mothers had knowledge of syphilis (27.8%). Rubella was the least known; only 12% of mothers were aware of rubella infection. District of residence and having knowledge of syphilis were predictors for rubella knowledge, while for syphilis knowledge, significant predictors were age group, occupation, and those having knowledge on HIV and rubella. Predictors for HIV knowledge were residential district, having a mobile phone, and those having knowledge of syphilis and rubella. Conclusions This study confirmed that mothers have low overall knowledge on MTCT infections. To achieve the MTCT elimination goals, targeted interventions to improve knowledge among women of childbearing age are recommended.
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Rac MWF, Stafford IA, Eppes CS. Congenital syphilis: A contemporary update on an ancient disease. Prenat Diagn 2020; 40:1703-1714. [PMID: 32362058 DOI: 10.1002/pd.5728] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/24/2020] [Accepted: 04/21/2020] [Indexed: 11/06/2022]
Abstract
Congenital syphilis (CS) rates reached a 20-year high in the United States in 2018. Unlike previous years, most babies diagnosed with CS were born to mothers who received prenatal care, indicative of the need for better provider education and guideline adherence. Current rates suggest that screening for syphilis should be performed at the first prenatal care visit and twice during the third trimester. There are two diagnostic algorithms available for use in the United States (traditional and reverse) and providers must understand how to perform each algorithm. Treatment should be administered according to stage of syphilis per Centers for Disease Control recommendations with best neonatal outcomes seen when treatment is initiated >30 days before delivery. Benzathine Penicillin G remains the only recommended treatment of syphilis during pregnancy. In viable pregnancies, a pretreatment ultrasound is recommended to identify sonographic evidence of fetal infection and treatment should be initiated with continuous fetal monitoring to evaluate for the Jarisch-Herxheimer reaction which can cause preterm labor and fetal distress. After adequate syphilotherapy, a fourfold decline in maternal nontreponemal titers may not be observed by delivery and does not correlate with rates of CS.
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Affiliation(s)
- Martha W F Rac
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Irene A Stafford
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Catherine S Eppes
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
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Teles H, Cachão J, Oliveira I, Neves VH. Symptomatic congenital syphilis: still a reality. BMJ Case Rep 2020; 13:13/6/e234812. [PMID: 32487531 DOI: 10.1136/bcr-2020-234812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Hugo Teles
- Department of Pediatrics, Centro Hospitalar de Setubal EPE, Setúbal, Portugal
| | - Joana Cachão
- Department of Pediatrics, Centro Hospitalar de Setubal EPE, Setúbal, Portugal
| | - Inês Oliveira
- Department of Pediatrics, Centro Hospitalar de Setubal EPE, Setúbal, Portugal
| | - Victor Hugo Neves
- Department of Pediatrics, Centro Hospitalar de Setubal EPE, Setúbal, Portugal
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Abstract
Importance Since 2013, the United States has seen a rise in cases of congenital syphilis, culminating in a relative increase of 153% from 2013 to 2017 and 918 reported cases in 2017. In all, 50% to 80% of pregnant women with syphilis experience an adverse pregnancy outcome including stillbirth or spontaneous abortion. Objective This article aims to review the current evidence and recommendations for management of syphilis in pregnancy. Evidence Acquisition Original research articles, review articles, and guidelines on syphilis were reviewed. Results In pregnancy, routine screening for syphilis is recommended on initiation of prenatal care. In high-risk populations, repeat testing is recommended in the early third trimester and at delivery. Penicillin remains the recommended treatment in pregnancy. After treatment, nontreponemal titers should be repeated at minimum during the early third trimester and at delivery to assess for serologic response. In high-risk populations, titers should be repeated monthly. Conclusion and Relevance Routine screening in pregnancy is essential for identification of syphilis infection and prevention of congenital syphilis. Subsequent adequate treatment with penicillin therapy more than 30 days before delivery and at the correct dosages depending on the stage of infection should be incorporated into clinical practice.
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Abstract
Congenital infections are infections transmitted from mother to child during pregnancy (transplacentally) or delivery (peripartum). They have the potential to adversely affect fetal development and long-term neurodevelopmental outcome through inflammatory, destructive, developmental, or teratogenic lesions of the brain. Because the fetal/neonatal brain has a limited capacity to respond to injury, early inflammatory changes may be difficult to visualize and only manifest as neurocognitive disability later in life. Teratogenic effects, which may include aberrations of neuronal proliferation and migration, are more easily visible on imaging, but may be equally difficult to use to predict long-term neurocognitive outcomes. This chapter reviews the general pathophysiology of congenital infection and describes the epidemiology, the antenatal and postnatal diagnosis, and the treatment of congenital infections as well as the long-term neurodevelopmental outcomes.
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Affiliation(s)
- Isabelle Boucoiran
- Mother and Child Infection Center, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada; Departments of Obstetrics and Gynecology and Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada.
| | - Fatima Kakkar
- Mother and Child Infection Center, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada; Department of Pediatrics, University of Montreal, Montreal, QC, Canada
| | - Christian Renaud
- Mother and Child Infection Center, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada; Department of Microbiology and Immunology, University of Montreal, Montreal, QC, Canada
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Bezerra MLDMB, Fernandes FECV, de Oliveira Nunes JP, de Araújo Baltar SLSM, Randau KP. Congenital Syphilis as a Measure of Maternal and Child Healthcare, Brazil. Emerg Infect Dis 2019; 25:1469-1476. [PMID: 31310223 PMCID: PMC6649332 DOI: 10.3201/eid2508.180298] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Syphilis is a sexually transmitted infection that has direct adverse effects on maternal and infant health through vertical Treponema pallidum transmission during early pregnancy. We evaluated congenital syphilis as a predictor of the quality of basic maternal and child healthcare in Brazil during 2010–2015. We investigated case rates and correlations with epidemiologic and socioeconomic indicators. We observed rising congenital syphilis incidence rates and increasing syphilis-associated perinatal and infant mortality rates in all regions. Case rates were highest in the Northeast, Southeast, and South, and congenital syphilis infant mortality rates were highest in the Northeast and Southeast. We observed correlations between congenital syphilis rates and infant death, spontaneous abortion (miscarriage), and stillbirth rates. We also noted correlations between rates of stillbirth caused by syphilis and inadequate prenatal care. Our study suggests gaps in basic healthcare for pregnant women and indicates the urgent need for measures to increase early diagnosis and appropriate treatment.
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Duby J, Bitnun A, Shah V, Shannon P, Shinar S, Whyte H. Non-immune Hydrops Fetalis and Hepatic Dysfunction in a Preterm Infant With Congenital Syphilis. Front Pediatr 2019; 7:508. [PMID: 31921721 PMCID: PMC6927290 DOI: 10.3389/fped.2019.00508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/22/2019] [Indexed: 11/13/2022] Open
Abstract
We report a case of a preterm infant with congenital syphilis who presented with non-immune hydrops fetalis. Hepatic dysfunction was present at birth and acutely worsened following antibiotic administration. Placental pathology demonstrated infiltration with numerous spirochetes. Although critically ill, the infant recovered with intravenous penicillin G and supportive care. This case demonstrates that congenital syphilis remains a contemporary disease demanding enhanced awareness from clinicians. Manifestations evident in utero or in the newborn can be severe and may result in fetal demise or neonatal death. Moreover, we hypothesize that the treatment resulted in a Jarisch-Herxheimer reaction as manifested by the hepatic deterioration. The incidence of congenital syphilis and its associated complications can be greatly reduced with strict adherence to universal prenatal testing and comprehensive follow-up.
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Affiliation(s)
- Jessica Duby
- Division of Neonatology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Ari Bitnun
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON, Canada
| | - Vibhuti Shah
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - Patrick Shannon
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathology, University of Toronto, Toronto, ON, Canada
| | - Shiri Shinar
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
| | - Hilary Whyte
- Division of Neonatology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
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Cavalcante ANM, Araújo MAL, Nobre MA, Almeida RLFD. Factors associated with inadequate follow-up of children with congenital syphilis. Rev Saude Publica 2019; 53:95. [PMID: 31644773 PMCID: PMC6802946 DOI: 10.11606/s1518-8787.2019053001284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 03/10/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To analyze factors associated with outpatient follow-up of children with congenital syphilis. METHODS A non-concurrent cohort study performed in primary care units and three reference maternity hospitals in Fortaleza (Ceará State). Data were collected from September 2013 to September 2016 in the notification forms and in the medical records of hospitalization and outpatient follow-up, and they were presented considering an adequate and inadequate follow-up. Children who attended the primary care unit or referral outpatient clinic during the period recommended by the Ministry of Health were considered adequately followed up and performed the recommended examinations. Pearson's chi-square and Fisher's exact tests were used in the comparative analysis. The estimated risk of adequate non-follow-up was verified by simple and multiple logistic regression. RESULTS The total of 460 children with congenital syphilis were notified, of which 332 (72.2%) returned for at least one appointment and were part of the study. Exactly 287 (86.4%) children attended the primary health unit; however, there was no reference to congenital syphilis in 236 (71.1%) medical records and no information on the venereal disease research laboratory (VDRL) test was found in 264 (79.5%) children. There was nonadherence to subsequent appointments by 272 (81.9%) individuals. The following variables had a statistically significant association with the non-adequate follow-up of the children: marital status of the mothers, number of prenatal appointments, number of pregnancies, blood count, and radiography of long bones. CONCLUSIONS Most children with congenital syphilis attended primary care for follow-up, but the services do not meet the recommendations of the Brazilian Ministry of Health for adequate follow-up.
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Affiliation(s)
- Ana Nery Melo Cavalcante
- Universidade de Fortaleza. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Coletiva. Fortaleza, CE, Brasil
| | - Maria Alix Leite Araújo
- Universidade de Fortaleza. Centro de Ciências da Saúde. Programa de Pós-Graduação em Saúde Coletiva. Fortaleza, CE, Brasil
| | - Marina Arrais Nobre
- Universidade de Fortaleza. Curso graduação em Medicina. Fortaleza, CE, Brasil
| | - Rosa Lívia Freitas de Almeida
- Universidade de Fortaleza. Centro de Ciências da Saúde. Programa de Pós-Graduação em Saúde Coletiva. Fortaleza, CE, Brasil
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Jacobs K, Vu DM, Mony V, Sofos E, Buzi N. Congenital Syphilis Misdiagnosed as Suspected Nonaccidental Trauma. Pediatrics 2019; 144:peds.2019-1564. [PMID: 31537633 DOI: 10.1542/peds.2019-1564] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2019] [Indexed: 11/24/2022] Open
Abstract
Congenital syphilis (CS) is a preventable infection, yet the incidence has surged to the highest rates in 20 years. Because 50% of live-born infants with CS are asymptomatic at birth, there is an increasing likelihood that pediatric providers will encounter older infants whose diagnoses were missed at birth, emphasizing the importance of timely prenatal screening and treatment. We present one such case of an infant admitted twice at 3 and 4 months of age with long bone fractures and suspected nonaccidental trauma. On her second presentation, several additional symptoms prompted evaluation for and eventual diagnosis of CS. In this case, it is demonstrated that an isolated long bone fracture can be a first presentation of CS, with other classic findings possibly appearing later. Pediatric providers should be familiar with the varied presentations of CS in older children, including the radiographic findings that we describe. The rising rates of CS reveal deficiencies in our current strategy to prevent CS and, thus, we recommend reconsideration of universal syphilis screening in the third trimester and at delivery, with timely treatment to prevent CS during pregnancy.
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Affiliation(s)
| | - David M Vu
- Lucile Packard Children's Hospital, Palo Alto, California.,Santa Clara Valley Medical Center, San Jose, California; and.,School of Medicine, Stanford University, Stanford, California
| | - Vidya Mony
- Santa Clara Valley Medical Center, San Jose, California; and
| | - Elvera Sofos
- Santa Clara Valley Medical Center, San Jose, California; and
| | - Nadav Buzi
- Santa Clara Valley Medical Center, San Jose, California; and
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Affiliation(s)
- Kenneth A Katz
- Associate Editor.,Department of Dermatology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
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Munoz A, Crane T, Hazboun R, Banerji A, Baerg J. Surgical consultation in neonates with congenital syphilis. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2018.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Walker GJA, Walker D, Molano Franco D, Grillo‐Ardila CF. Antibiotic treatment for newborns with congenital syphilis. Cochrane Database Syst Rev 2019; 2:CD012071. [PMID: 30776081 PMCID: PMC6378924 DOI: 10.1002/14651858.cd012071.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Congenital syphilis continues to be a substantial public health problem in many parts of the world. Since the first use of penicillin for the treatment of syphilis in 1943, which was a notable early success, it has remained the preferred and standard treatment including for congenital syphilis. However, the treatment of congenital syphilis is largely based on clinical experience and there is extremely limited evidence on the optimal dose or duration of administration of penicillin or the use of other antibiotics. OBJECTIVES To assess the effectiveness and safety of antibiotic treatment for newborns with confirmed, highly probable and possible congenital syphilis. SEARCH METHODS We searched the Cochrane STI Group Specialized Register, CENTRAL, MEDLINE, Embase, LILACS, WHO ICTRP, ClinicalTrials.gov and Web of Science to 23 May 2018. We also handsearched conference proceedings, contacted trial authors and reviewed the reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing antibiotic treatment (any concentration, frequency, duration and route) with no intervention or any other antibiotic treatment for neonates with confirmed, highly probable or possible congenital syphilis. DATA COLLECTION AND ANALYSIS All review authors independently assessed trials for inclusion, extracted data and assessed the risk of bias in the included studies. We resolved any disagreements through consensus. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS Two RCTs (191 participants) met our inclusion criteria and none of these trials was funded by the industry. One trial (22 participants) compared benzathine penicillin with no intervention for infants with possible congenital syphilis. Low-quality evidence suggested that benzathine penicillin administration may not have decreased the rate of neonatal death due to any cause (risk ratio (RR) 0.83, 95% confidence interval (CI) 0.06 to 11.70), and showed a possible reduction into the proportion of neonates with clinical manifestations of congenital syphilis (RR 0.12, 95% CI 0.01 to 2.09). Penicillin administration increased the serological cure at the third month (RR 2.13, 95% CI 1.06 to 4.27). These results should be taken with caution, because the trial was stopped early because there were four cases with clinical congenital syphilis in the no treatment group and none in the treatment group. Interim analysis suggested this difference was significant. This study did not report neonatal death due to congenital syphilis or the frequency of serious or minor adverse events after therapy. We downgraded the quality of evidence because of imprecision and risk of bias.One trial (169 participants) compared benzathine penicillin versus procaine benzylpenicillin. High- and moderate-quality evidence suggested that there were probably no differences between benzathine penicillin and procaine benzylpenicillin for the outcomes: absence of clinical manifestations of congenital syphilis (RR 1.00, 95% CI 0.97 to 1.03) and serological cure (RR 1.00, 95% CI 0.97 to 1.03). There were no cases of neonatal death due congenital syphilis; all 152 babies who followed up survived. This study did not report on the frequency of serious or minor adverse events after therapy. We downgraded the quality of evidence because of serious risk of bias. AUTHORS' CONCLUSIONS At present, the evidence on the effectiveness and safety of antibiotic treatment for newborns with confirmed, highly probable or possible congenital syphilis is sparse, implying that we are uncertain about the estimated effect. One trial compared benzathine penicillin with no intervention for infants with possible congenital syphilis. Low-quality evidence suggested penicillin administration possibly reduce the proportion of neonates with clinical manifestations of congenital syphilis, penicillin administration increased the serological cure at the third month. These findings support the clinical use of penicillin in neonates with confirmed, highly probable or possible congenital syphilis. High- and moderate-quality evidence suggests that there are probably no differences between benzathine penicillin and procaine benzylpenicillin administration for the outcomes of absence of clinical manifestations of syphilis or serological cure.
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Affiliation(s)
- Godfrey JA Walker
- The University of LiverpoolC/o Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
| | - Damian Walker
- Bill & Melinda Gates FoundationCost‐Effectiveness, Integrated Delivery, Global DevelopmentSeattleUSAWA 98102
| | - Daniel Molano Franco
- Fundacion Universitaria de Ciencias de la Salud, Hospital de San JoséDepartment of Critical CareCarrera 19 # 8‐32BogotaBogotaColombia11001
| | - Carlos F Grillo‐Ardila
- Faculty of Medicine, Universidad Nacional de ColombiaDepartment of Obstetrics and GynecologyCarrera 30 No 45‐03BogotaColombia
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Abstract
Syphilis, caused by Treponema pallidum, is transmitted both sexually and transplacentally. Untreated syphilis is a progressive disease that may result in death or disability in children and adults. Syphilis diagnosis requires 2-stage serologic testing for nontreponemal and treponemal antibodies. Congenital syphilis diagnosis requires careful review of maternal testing and treatment, comparison of maternal and neonatal nontreponemal antibody titers, and clinical evaluation of the neonate. In this review, we present the current epidemiology of syphilis, and the clinical manifestations, diagnosis, and management of syphilis as they relate to pediatric practice, specifically, congenital syphilis and acquired syphilis in adolescents and pregnant women.
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Affiliation(s)
- Sarah Heston
- Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Faculty Office Building, 49 North Dunlap Street, Room 293, Memphis, TN 38105, USA
| | - Sandra Arnold
- Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Faculty Office Building, 49 North Dunlap Street, Room 293, Memphis, TN 38105, USA.
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Elarrat Canto SV, Leite Araújo MA, Espinosa Miranda A, Paulo Cardoso AR, Freitas de Almeida RL. Fetal and infant mortality of congenital syphilis reported to the Health Information System. PLoS One 2019; 14:e0209906. [PMID: 30608958 PMCID: PMC6319744 DOI: 10.1371/journal.pone.0209906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 12/13/2018] [Indexed: 11/19/2022] Open
Abstract
Background Congenital syphilis (CS) is a major cause of mortality in several countries, especially in Latin America and the Caribbean. This study aimed to analyze fetal and infant mortality of CS reported to the Health Information System in a State in Northeastern Brazil. Methods and results This was a cross-sectional study that analyzed the deaths of CS from 2010 to 2014 through the linkage of the Mortality Information System (SIM) and the Notifiable Diseases Information System (Sinan). The Statistical Package for the Social Sciences (SPSS) version 23.0 was used to calculate the rates of Fetal, Perinatal, Neonatal (early and late), and Postneonatal Mortality. Simple linear regression was performed. Fisher's exact test or Pearson's chi-square test were used for comparison of proportions and Student's t-test was used for comparison of means. Of the 414 cases reported to the SIM as deaths possibly caused by CS, 44 (10.6%) presented CS as the underlying cause. From 2010 to 2014 the Infant Mortality Rate of CS was 16.3 per 100,000 live births (y = 0.65x + 14.33, R2 = 0.2338, p = 0.003). There was an 89.4% underreporting of deaths. Perinatal deaths and fetal deaths of CS accounted for 87.7% and 73.9% of total deaths, respectively. Conclusions The results of the study revealed a significant Fetal and Infant Mortality rate of CS and demonstrated the importance of using the linkage method in studies that involve the analysis of secondary data obtained from mortality and disease reporting systems. The underreporting of CS as a cause of fetal and infant mortality leads to unawareness of the reality of deaths from this disease, hindering the development of public policies aimed at its prevention.
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Affiliation(s)
| | - Maria Alix Leite Araújo
- Collective Health Post Graduation Program, University of Fortaleza, Fortaleza, Ceará, Brazil
| | - Angélica Espinosa Miranda
- Department of Social Medicine, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Ana Rita Paulo Cardoso
- Department of Health Surveillance, Ceará State Secretary of Health, Fortaleza, Ceará, Brazil
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Congenital Syphilis: A Discussion of Epidemiology, Diagnosis, Management, and Nurses' Role in Early Identification and Treatment. Adv Neonatal Care 2018; 18:438-445. [PMID: 30020089 DOI: 10.1097/anc.0000000000000534] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Syphilis is caused by the spirochete bacterium Treponema pallidum. Syphilis left untreated, or inadequately treated during pregnancy, can result in congenital syphilis (CS). Congenital syphilis can lead to severe sequelae or fetal, neonatal, or infant death. PURPOSE To discuss the epidemiological trends, pathophysiology, diagnosis, and management of CS; the implications of CS upon the infant; as well as the importance of the nurse's role in the prompt identification of CS and the timely interventions needed to minimize sequelae. METHODS A literature search was completed using ProQuest, CINAHL, Google Scholar, and PubMed. Articles published within the past 10 years were included. FINDINGS Epidemiological trends of CS in the United States indicate that maternal syphilis infection and CS are on the rise. Risk factors include ethnicity, socioeconomic status, access to prenatal care, and sexual behaviors, as well as compliance with prenatal syphilis screening by prenatal providers. Risks of CS to the developing fetus begin at approximately 14 weeks. Timely treatment is necessary to minimize or eliminate mortality and morbidity. IMPLICATIONS FOR PRACTICE Evidence-based, interprofessional strategies, which promote a collaborative perinatal/neonatal preventative approach to care of the pregnant female, are indicated to reverse the increasing incidence of CS within the United States. Strategies prioritizing early identification and treatment of at-risk neonates are necessary to reduce/eliminate the devastating long-term consequences of CS upon this vulnerable population. IMPLICATIONS FOR RESEARCH The paucity of research, which focuses on CS, is most likely due to ethical concerns related to infants as research participants and provides an opportunity for future research. Future research could focus on factors that focus on maternal-fetal/maternal-child transmission of CS.
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Abstract
BACKGROUND There are minimal neurodevelopmental follow-up data for infants exposed to syphilis in utero. METHODS This is an inception cohort study of infants exposed to syphilis in utero. We reviewed women with reactive syphilis serology in pregnancy or at delivery in Edmonton (Canada), 2002 through 2010 and describe the neurodevelopmental outcomes of children with and without congenital syphilis. RESULTS There were 39 births to women with reactive syphilis serology, 9 of whom had late latent syphilis (n = 4), stillbirths (n = 2) or early neonatal deaths (n = 3), leaving 30 survivors of which 11 with and 7 without congenital syphilis had neurodevelopmental assessment. Those with congenital syphilis were all born to women with inadequate syphilis treatment before delivery. Neurodevelopmental impairment was documented in 3 of 11 (27%) infants with congenital syphilis and one of 7 (14%) without congenital syphilis with speech language delays in 4 of 11 (36%) with congenital syphilis and 3 of 7 (42%) without congenital syphilis. CONCLUSIONS Infants born to mothers with reactive syphilis serology during pregnancy are at high risk for neurodevelopmental impairment, whether or not they have congenital syphilis, so should all be offered neurodevelopmental assessments and early referral for services as required.
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A Case of Congenital Syphilis Presenting with Unusual Skin Eruptions. Case Rep Pediatr 2018; 2018:1761454. [PMID: 29770234 PMCID: PMC5889854 DOI: 10.1155/2018/1761454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 03/07/2018] [Indexed: 11/23/2022] Open
Abstract
Once believed to be a rare disease in developed countries, recent data suggest that there is a surge in incidence of congenital syphilis in many developed countries. Diagnosis of congenital syphilis can be difficult because more than two-thirds of affected infants are asymptomatic at birth, and signs of symptomatic infants may be nonspecific or subtle. On top of this, some affected infants may have atypical presentations. Familiarity with the diverse presentations is essential to diagnosis. We report a 2-week-old male infant with congenital syphilis whose cutaneous manifestations included diffuse, erythematous keratoderma with desquamation and fissures on his hands and feet, multiple linear scaly fissures at the angles of his mouth, and onychauxis of the fingernails and toenails To our knowledge, diffuse, erythematous keratoderma of the hands and feet and thick nails have not been reported previously in congenital syphilis.
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Feliz MC, de Medeiros ARP, Rossoni AM, Tahnus T, Pereira AMVB, Rodrigues C. Adherence to the follow-up of the newborn exposed to syphilis and factors associated with loss to follow-up. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2018; 19:727-739. [PMID: 28146163 DOI: 10.1590/1980-5497201600040004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 09/08/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction All newborns exposed to syphilis in pregnancy must have outpatient follow-up. The interruption of this follow-up especially threatens those children who were not treated at birth. Objective To describe the clinical, epidemiological, and sociodemographic characteristics of pregnant women with syphilis and their newborns, and to investigate the factors associated with the discontinuation of the follow-up. Methods This is an observational, descriptive, analytical, and retrospective study of medical records of 254 children exposed to syphilis, who were assisted at the Congenital Infectious Clinic of the university hospital of the Universidade Federal do Paraná, between 2000 and 2010. The newborns were classified by reference according to their follow-up. Data were analyzed by means of the binary logistic regression model in order to identify the factors associated to drop out. Results The factors associated to the interruption of the follow-up were maternal age over 30 years, mothers with 3 or more children, and the absence of cross-infections by HIV and/or viral hepatitis. Conclusion Such findings demonstrate the need to identify these families and implement strategies to promote the establishment of bonds. A greater rigor to indicate the treatment of the disease at birth is recommended, as most of them do not properly follow up.
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Affiliation(s)
- Marjorie Cristiane Feliz
- Programa de Pós-graduação em Ciências da Saúde da Criança e Adolescente, Universidade Federal do Paraná - Curitiba (PR), Brasil
| | | | - Andrea Maciel Rossoni
- Serviço de Infectologia Pediátrica do Hospital de Clínicas, Universidade Federal do Paraná - Curitiba (PR), Brasil
| | - Tony Tahnus
- Serviço de Infectologia Pediátrica do Hospital de Clínicas, Universidade Federal do Paraná - Curitiba (PR), Brasil
| | | | - Cristina Rodrigues
- Programa de Pós-graduação em Ciências da Saúde da Criança e Adolescente, Universidade Federal do Paraná - Curitiba (PR), Brasil
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Hebmuller MG, Fiori HH, Lago EG. Subsequent pregnancies in women with previous gestational syphilis. CIENCIA & SAUDE COLETIVA 2017; 20:2867-78. [PMID: 26331518 DOI: 10.1590/1413-81232015209.20332014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This study included data on syphilis-positive pregnant women seen for delivery or miscarriage, between 1997 and 2004, in Sao Lucas Hospital, Porto Alegre, RS. Their subsequent obstetric outcomes were studied, until December 2011, to see if the disease recurred. From 450 pregnant women with positive syphilis serology, seen from 1997 to 2004, 166 had at least one more obstetric attendance until December 2011, with 266 new obstetric outcomes. Congenital syphilis (CS) was demonstrated in 81.9% of the initial pregnancies and in 68.4% of the subsequent ones. The main causes of CS in subsequent pregnancies were a negative VDRL that turned positive at delivery, and undocumented treatment. VDRL titers were higher than 1:4 in 50.4% of the initial and 13.3% of the subsequent pregnancies (p < 0.01). Perinatal mortality rate was 119/1000 in initial and 41/1000 in subsequent pregnancies (p < 0.01). CS recurrence was frequent in subsequent pregnancies of women who tested positive for syphilis in a preceding pregnancy. No or inadequate prenatal care was the main risk factor for CS, both in initial and in subsequent pregnancies. These data suggest that non-infected neonates could have been defined as CS cases because of insufficient information about the mother's history.
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Affiliation(s)
- Marjorie Garlow Hebmuller
- Departamento de Pediatria, Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, BR,
| | - Humberto Holmer Fiori
- Departamento de Pediatria, Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, BR,
| | - Eleonor Gastal Lago
- Departamento de Pediatria, Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, BR,
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Patel NU, Oussedik E, Landis ET, Strowd LC. Early Congenital Syphilis: Recognising Symptoms of an Increasingly Prevalent Disease. J Cutan Med Surg 2017; 22:97-99. [PMID: 28821219 DOI: 10.1177/1203475417728360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Congenital syphilis (CS) is an infectious disease resulting from transplacental transmission of Treponema pallidum spirochetes from an infected mother to fetus during pregnancy. While uncommon, CS has shown an increased incidence in Canada and the United States since 2001 and 2012, respectively. CASE REPORT We present the case of a 5-week-old female infant with blistering rash on the palms and soles. The infant displayed decreased movement of the left upper extremity, clinically consistent with Parrot pseudoparalysis. Cutaneous involvement was limited to few tan crusted papules on the palms and soles. Mother reported a "false-positive" result of rapid plasma reagin (RPR) testing at 31 weeks. Cerebrospinal fluid studies of the infant resulted with positive Venereal Disease Research Laboratory (VRDL) test and positive microhemagglutination assay (MHA-TP). Histopathology of a crusted papule revealed a lichenoid infiltrate composed of lymphocytes, histiocytes, and plasma cells. Immunohistochemical staining for T pallidum was negative. The patient completed treatment with a 10-day course of intravenous penicillin. DISCUSSION While CS is largely considered a historic entity, it has been increasing in incidence in the United States since 2012 and in Canada since the early 2000s. Diagnosis of CS can be difficult as infants may be asymptomatic or present with nonspecific signs. This case highlights the presentation of minimal cutaneous involvement as well as skeletal involvement after birth. RPR testing may result in false negatives or indeterminate results, further complicating diagnosis. Given these difficulties in screening and the increasing incidence of CS, clinicians may need to refamiliarise themselves with its clinical findings.
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Affiliation(s)
- Nupur U Patel
- 1 Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Elias Oussedik
- 1 Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Erin T Landis
- 1 Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lindsay C Strowd
- 1 Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Dos Santos RR, Niquini RP, Bastos FI, Domingues RMSM. Diagnostic and Therapeutic Knowledge and Practices in the Management of Congenital Syphilis by Pediatricians in Public Maternity Hospitals in Brazil. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2017; 49:322-342. [PMID: 28735562 DOI: 10.1177/0020731417722088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The study aimed to assess conformity with Brazil's standard protocol for diagnostic and therapeutic practices in the management of congenital syphilis by pediatricians in public maternity hospitals. A cross-sectional study was conducted in 2015 with 41 pediatricians working in all the public maternity hospitals in Teresina, the capital of Piauí State, Northeast Brazil, through self-completed questionnaires. The study assessed the conformity of knowledge and practices according to the Brazilian Ministry of Health protocols. The study has made evident low access to training courses (54%) and insufficient knowledge of the case definition of congenital syphilis (42%) and rapid tests for syphilis (39%). Flaws were observed in the diagnostic workup and treatment of newborns. Requesting VDRL (88%) and correct treatment of neurosyphilis (88%) were the practices that showed the highest conformity with standard protocols. Low conformity with protocols leads to missed opportunities for identifying and adequately treating congenital syphilis. Based on the barriers identified in the study, better access to diagnostic and treatment protocols, improved recording on prenatal cards and hospital patient charts, availability of tests and medicines, and educational work with pregnant women should be urgently implemented, aiming to reverse the currently inadequate management of congenital syphilis and to curb its spread.
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Affiliation(s)
| | - Roberta Pereira Niquini
- 2 Instituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Francisco Inácio Bastos
- 3 Instituto de Comunicação e Informação Científica e Tecnológica em Súde, Rio de Janeiro, Brazil
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Kitt E, May RM, Steenhoff AP. Rash and hepatosplenomegaly in a newborn. JMM Case Rep 2017; 4:e005098. [PMID: 29026625 PMCID: PMC5630967 DOI: 10.1099/jmmcr.0.005098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 05/19/2017] [Indexed: 11/18/2022] Open
Affiliation(s)
- Eimear Kitt
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Suite 1202 ARC 3615, Civic Center Boulevard, Philadelphia, PA 1910-4318, USA
| | - Rebecca M May
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104-4238, USA
| | - Andrew P Steenhoff
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Suite 1202 ARC 3615, Civic Center Boulevard, Philadelphia, PA 1910-4318, USA
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46
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Iwahashi M, Kusama Y. Congenital syphilis. Pediatr Int 2017. [PMID: 28626975 DOI: 10.1111/ped.13275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Megumi Iwahashi
- Department of Pediatrics, Jikei University Kashiwa Hospital, Chiba, Japan.,Department of Pediatrics, Jikei University School of Medicine, Tokyo, Japan
| | - Yoshiki Kusama
- Department of Pediatrics, Jikei University School of Medicine, Tokyo, Japan.,Department of Pediatrics, Fuji City General Hospital, Shizuoka, Japan
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Zhang XH, Xu J, Chen DQ, Guo LF, Qiu LQ. Effectiveness of treatment to improve pregnancy outcomes among women with syphilis in Zhejiang Province, China. Sex Transm Infect 2016; 92:537-541. [PMID: 27091728 DOI: 10.1136/sextrans-2015-052363] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 02/09/2016] [Accepted: 03/05/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To determine the effectiveness of treatment in improving pregnancy outcomes among women with syphilis. METHODS This is a retrospective study based on the provincial prevention of mother-to-child transmission of syphilis database. All women with syphilis with singleton pregnancies were recruited. We evaluated their pregnancy outcomes by group-specific analyses according to their treatment time and adequacy. RESULTS The syphilis prevalence among pregnant women was 0.3% (4214/1 338 739) in Zhejiang Province, China, during 2013-2014, considering all live births and abortions. Women with singleton pregnancies (3767) were included in the study, including live births and stillbirths (≥28 weeks). The treatment coverage for all women with syphilis was 80.2% (3022/3767), and 68.2% (2062/3022) of the women were treated adequately. Of 745 infants born to untreated pregnant women with syphilis, 1.2% manifested pneumonia, 2.7% asphyxia, 1.6% birth defects, 3.8% congenital syphilis (CS), 14.2% were preterm, 10.1% had low birth weight (LBW) and 3.1% experienced perinatal death. The risks of asphyxia (OR=2.7), CS (OR=3.1), preterm birth (OR=1.5), LBW (OR=1.9) and perinatal death (OR=3.1) were much higher in infants born to mothers treated inadequately than from those treated adequately. Moreover, mothers with syphilis who initiated treatment in the third trimester suffered an increased risk for asphyxia (OR=3.0), CS (OR=6.0) and LBW (OR=1.7) compared with those who initiated treatment in the first trimester. CONCLUSIONS Early and adequate treatment could improve the adverse pregnancy outcomes among women with syphilis.
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Affiliation(s)
- Xiao-Hui Zhang
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, People's Republic of China
| | - Jian Xu
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, People's Republic of China
| | - Dan-Qing Chen
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, People's Republic of China
| | - Li-Fang Guo
- Women Hospital of Hang Zhou, Hangzhou, People's Republic of China
| | - Li-Qian Qiu
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, People's Republic of China
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Lago EG. Current Perspectives on Prevention of Mother-to-Child Transmission of Syphilis. Cureus 2016; 8:e525. [PMID: 27081586 PMCID: PMC4829408 DOI: 10.7759/cureus.525] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 03/09/2016] [Indexed: 12/21/2022] Open
Abstract
This article aims to provide an update on the prevention of mother-to-child transmission of syphilis by drawing upon some important basic concepts and reviewing the most recent literature on the diagnosis and treatment of syphilis in pregnancy. New technologies, such as automated and point-of-care immunologic tests, are shifting some paradigms, which will certainly be further investigated in the forthcoming years. This is the time to carefully evaluate traditional as well as new strategies to prevent congenital syphilis. Adverse outcomes of mother-to-child transmission of syphilis can be prevented with antenatal screening and penicillin therapy, which proved to have an excellent cost-benefit ratio even in populations with a low prevalence of syphilis. However, syphilis epidemiology is influenced by socioeconomic and cultural factors, and major challenges are faced by poor and developing countries in which the severity of the problem is extremely alarming. On the other hand, the emergence of new technologies has raised doubts about the best algorithm to be used when proper laboratory resources are available. Conditions are quite heterogeneous across populations, and some procedures should not be generalized while there is no evidence that supports some changes and while in-depth studies about local conditions are not conducted. Official organizations need to be alert in order to avoid isolated decisions and ensure that evidence-based guidelines be used in the management of syphilis in pregnancy.
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Affiliation(s)
- Eleonor G Lago
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS ; Edipucrs University Publisher, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS
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Characterization and six-month follow-up on a cohort of newborns with congenital syphilis. BIOMEDICA 2016; 36:101-8. [PMID: 27622443 DOI: 10.7705/biomedica.v36i1.2661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 08/10/2015] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Congenital syphilis is a preventable disease. However, the incidence in Colombia has increased and reached the figure of 3.28 cases per 1,000 live births in 2011. OBJECTIVE To characterize newborns with congenital syphilis and describe follow-up over 6 months following their diagnosis and treatment. MATERIALS AND METHODS Between August, 2011, and February, 2012, in Hospital La Victoria, sede Instituto Materno Infantil, newborns with congenital syphilis were identified and treated. Clinical and laboratory follow-up was carried out for six months until it was determined that the disease was cured. The analyzed variables included patients' clinical and laboratory characteristics. RESULTS In this period, we identified 29 cases that met the criteria of congenital syphilis, with a frequency in the institution of one case per 69 births. There was one stillbirth and one neonatal death, four were premature, and five had growth restriction. Of the 28 live births, 15 were asymptomatic. There were two cases with neurosyphilis, representing 15% of symptomatic newborns. Follow-up was done on 18 out of 27 children (66.6%), including most symptomatic cases and the two cases of neurosyphilis. All cases showed the expected decrease in VDRL titers without clinical sequelae, meeting the criteria of being cured. CONCLUSIONS A high incidence of the disease, failure to prevent it, varied expression in its presentation, and the effectiveness of treatment in the neonatal period were evidenced in this study.
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Congenital syphilis: trends in mortality and morbidity in the United States, 1999 through 2013. Am J Obstet Gynecol 2016; 214:381.e1-9. [PMID: 26470826 DOI: 10.1016/j.ajog.2015.10.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/30/2015] [Accepted: 10/06/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Congenital syphilis (CS) results when an infected pregnant mother transmits syphilis to her unborn child prior to or at delivery. The severity of infection can range from a delivery at term without signs of infection to stillbirth or death after delivery. OBJECTIVE We sought to describe CS morbidity and mortality during 1999 through 2013. STUDY DESIGN National CS case data reported to Centers for Disease Control and Prevention during 1999 through 2013 were analyzed. Cases were classified as dead (stillbirths and deaths up to 12 months after delivery), morbid (cases with strong [physical, radiographic, and/or nonserologic laboratory] evidence of CS), and nonmorbid (cases with a normal physical examination reported, without strong evidence of infection). Annual rates of these cases were calculated. Cases were compared using selected maternal and infant criteria. RESULTS During 1999 through 2013, 6383 cases of CS were reported: 6.5% dead, 33.6% morbid, 53.9% nonmorbid, and 5.9% unknown morbidity; 81.8% of dead cases were stillbirths. Rates of dead, morbid, and nonmorbid cases all decreased over this time period, but the overall proportions that were dead or morbid cases did not significantly change. The overall case fatality ratio during 1999 through 2013 was 6.5%. Among cases of CS, maternal race/ethnicity was not associated with increased morbidity or death, although most cases (83%) occurred among black or Hispanic mothers. No or inadequate treatment for maternal syphilis, <10 prenatal visits, and maternal nontreponemal titer ≥1:8 increased the likelihood of a dead case; risk of a dead case increased with maternal nontreponemal titer (χ(2) for trend P < .001). Infants with CS born alive at <28 weeks' gestation (relative risk, 107.4; P < .001) or born weighing <1500 g (relative risk, 43.9; P < .001) were at greatly increased risk of death. CONCLUSION CS remains an important preventable cause of perinatal morbidity and mortality, with comparable case fatality ratios during 1999 through 2013 (6.5%) and 1992 through 1998 (6.4%). Detection and treatment of syphilis early during pregnancy remain crucial to reducing CS morbidity and mortality.
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