Congenital syphilis overview
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2] Kalsang Dolma, M.B.B.S.[3]
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Overview
Congenital Syphilis is caused by Treponema pallidum, its transmitted to the fetus in utero from an infected mother via the placenta. The severity of the disease is dependent on the stage of maternal infection and the duration of exposure to the fetus. Transmission is typically in the second trimester and the highest rates of transmission are seen in women with primary syphilis. The rates of transmission decrease with the increasing duration of the maternal infection, as the concentration of spirochetes in the blood stream decreases. Syphilis infection to the fetus in utero can result in stillborn, miscarriage and a live birth with severe manifestations of hydrops. Prenatal screening for syphilis during the first trimester is recommended to all pregnant women and adequate treatment with penicillin prevents the transmission to the fetus.
Historical Perspective
Congenital syphilis was first described in an English 17th century in a pediatric textbook. Transplacental transmission from an asymptomatic infected mother was first described in 1906. Sir Jonathan Hutchinson described the triad of notched incisors, interstitial keratitis, and eighth cranial nerve deafness as a criterion for diagnosis of congenital syphilis.
Classification
Congenital syphilis can be classified into early (presenting 0-2 years) and late (greater 2 years) based upon on time of presentation. There is also a diagnostic classification of syphilis used for surveillance purpose.
Pathophysiology
Pathophysiology of congenital syphilis is still unclear. Several theories have been postulated in regards to duration of infection in mother and stage of pregnancy.
Causes
Congenital syphilis is caused by the bacterium Treponema pallidum, which is passed from mother to child during fetal development or at birth. Nearly half of all children infected with syphilis while they are in the womb die shortly before or after birth.
Screening
Routine screening of newborn serum or umbilical cord blood is not recommended. Serologic testing of the mother’s serum is preferred rather than testing of the infant’s serum.
Diagnosis
X Ray
All infants delivered of women with a reactive STS (serologic tests for syphilis) who were not treated before pregnancy or before 20 weeks' gestation should be fully evaluated. The evaluation should include an examination of the long bones for osteochondritis, osteitis, and periostitis.[1]
Other Diagnostic Studies
Pathologic examination of the placenta or umbilical cord by using specific fluorescent antitreponemal antibody staining is suggested.
Treatment
Medical Therapy
An afflicted child can be treated using antibiotics much like an adult, however any developmental symptoms are likely to be permanent.
References
- ↑ "Guidelines for the Prevention and Control of Congenital Syphilis". Retrieved 2012-12-21.