Congenital syphilis pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2] Aravind Kuchkuntla, M.B.B.S[3]
Overview
Pathophysiology of congenital syphilis is still unclear. Several theories have been postulated in regards to the duration of the mother's infection as well as the stage of pregnancy in which infection occurs.
Pathophysiology
Pahogenesis
- Transmission to the fetus is primarily transplacental but it can also occur during delivery in the presence of maternal genital lesions.[1][2][3]
- The risk of transmission to the fetus is dependent on the stage of the maternal disease (dependent on the spirochete concentration in the blood stream) and the duration of exposure to the fetus in utero.[4]
- The risk of vertical transmission of syphilis from an infected untreated mother decreases as maternal disease duration progresses: transmission risk of 70–100% for primary syphilis and 40% for early latent syphilis to 10% for late latent disease. The variation in the percentages with the duration of infection is due to the concentration of spirochetes in the blood stream, which decrease with the duration of maternal syphilis infection.[5]
- Kassowitz's law describes the inverse relationship of interval between the disease and pregnancy. Longer the interval between infection and pregnancy more benign is the outcome.[6]
- Transmission of infection typically takes place between the 16th and 28th week of pregnancy, however the transmission can be as early as the first trimester of pregnancy.[7]
References
- ↑ Wicher V, Wicher K (2001). "Pathogenesis of maternal-fetal syphilis revisited". Clin Infect Dis. 33 (3): 354–63. doi:10.1086/321904. PMID 11438902.
- ↑ Domingues RM, Leal Mdo C (2016). "[Incidence of congenital syphilis and factors associated with vertical transmission: data from the Birth in Brazil study]". Cad Saude Publica. 32 (6). doi:10.1590/0102-311X00082415. PMID 27333146.
- ↑ Peeling RW, Hook EW (2006). "The pathogenesis of syphilis: the Great Mimicker, revisited". J Pathol. 208 (2): 224–32. doi:10.1002/path.1903. PMID 16362988.
- ↑ Berman SM (2004). "Maternal syphilis: pathophysiology and treatment". Bull World Health Organ. 82 (6): 433–8. PMC 2622860. PMID 15356936.
- ↑ Genç M, Ledger WJ (2000). "Syphilis in pregnancy". Sex Transm Infect. 76 (2): 73–9. PMC 1758294. PMID 10858706.
- ↑ Balaji G, Kalaivani S (2013). "Observance of Kassowitz law-late congenital syphilis: Palatal perforation and saddle nose deformity as presenting features". Indian J Sex Transm Dis. 34 (1): 35–7. doi:10.4103/0253-7184.112869. PMC 3730472. PMID 23919053.
- ↑ Harter C, Benirschke K (1976). "Fetal syphilis in the first trimester". Am. J. Obstet. Gynecol. 124 (7): 705–11. PMID 56895.