Clinical aspects, diagnosis and therapy of syphilis in pregnancy and in newborn infants

Abstract

A clinically manifest primary or secondary syphilis that develops during pregnancy has become an extremely rare occurrence. What is more frequently found in pregnant women, however, is a reactive syphilis serology where there is otherwise an absence of clinical symptoms or where, at least, there are untypical symptoms. What has to be decided in these cases is whether one is dealing with latent seropositive syphilis that can be transmitted to the child and thus needs to be treated, or with a serum scar resulting from an infection which occurred some time before. As a rule, this decision can be reached serologically by demonstrating Treponema-specific IgM antibodies by means of the 19S-IgM-FTA-ABS test or some similar methods. In the case of specific IgM detection, immediate treatment of the mother, and thus of the child, is important. Daily intramuscular injections of 1 million I.U. penicillin over a total of 21 days are recommended. Only in proved cases of penicillin allergy should one resort to erythromycin; although it must be said that there is no guarantee that this will produce a therapeutically sufficient fetal blood level. In rare cases such as these, the child must therefore be retreated with penicillin after birth. Today, the clinical signs of premature or retarded congenital syphilis are hardly ever seen in their classic form. Symptoms are frequently uncharacteristic - especially in the case of premature births - and can only be distinguished from other congenital infections with difficulty.(ABSTRACT TRUNCATED AT 250 WORDS)