Evidence Of Congenital Syphilis Research Articles

Alternative Treatments for Syphilis During Pregnancy.

Alternative Treatments for Syphilis During Pregnancy.

Effects on preventing mother-to-child transmission of syphilis and associated adverse pregnant outcomes: a longitudinal study from 2001 to 2015 in Shanghai, China

BackgroundMaternal syphilis is a health threat to both the pregnant women and the children. This study aimed to delineate the longitudinal trend of maternal syphilis and burden of associated adverse pregnant outcomes (APOs) in Shanghai from 2001 to 2015; and to evaluate the effects of preventing mother-to-child transmission (PMTCT) of syphilis in Shanghai with regard to service coverage and APOs averted.MethodsPMTCT program of syphilis has been implemented since 2001. Municipal and national PMTCT surveillance data were used in analysis. By using WHO estimation model, the burden of associated APOs and APOs averted were estimated. The differences in access to antenatal care and PMTCT services between resident and non-resident pregnant women were analyzed.ResultsThe prevalence of seropositivity for maternal syphilis in Shanghai ranged from 0.20% to 0.38% during 2001–2015. The treatment rate varied from 69.8% to 96.8% and remained 83.6% in 2015. Under the PMTCT program, 2163 APOs had been averted during the 15-year period, including 852(39.4%) early fetal loss/stillbirth, 356(16.4%) neonatal death, 190(8.8%) prematurity or low birth weight, and 765(35.4%) clinical evidence of congenital syphilis. Compared with the residents, the non-resident pregnant women had a higher prevalence of syphilis (1.2‰ vs. 2.5‰) and contributed to 81.7% of the syphilis associated APOs in 2015.ConclusionScreening of maternal syphilis has reached a full coverage both in residents and non-residents. Large numbers of APOs has been averted attributing to the PMTCT program. More attentions should be paid to those vulnerable non-resident pregnant women and tailored interventions including health education, PMTCT promotion and point of care should be given to maximize the effects of PMTCT in Shanghai.

Congenital syphilis: trends in mortality and morbidity in the United States, 1999 through 2013

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. We sought to describe CS morbidity and mortality during 1999 through 2013. 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. 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. 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.

Evidence of congenital syphilis and tubercolosis in a XIX Century mummy (Perugia, Italy)

Evidence of congenital syphilis and tubercolosis in a XIX Century mummy (Perugia, Italy)

Evidence of congenital syphilis and tubercolosis in a XIX Century mummy (Perugia, Italy)

Evidence of congenital syphilis and tubercolosis in a XIX Century mummy (Perugia, Italy)

Congenital syphilis and fluorescent treponemal antibody test reactivity after the age of 1 year.

Many believe that a persistently reactive fluorescent treponemal antibody absorption (FTA-ABS) is manifested with congenital syphilis after the age of 1 year, that it is useful in the retrospective diagnosis of children with congenital syphilis, and that it can be used to confirm other treponemal tests. To determine whether a reactive FTA-ABS after the age of 12 months is indicative of congenital syphilis. Prospective outpatient follow-up evaluation until at least the age of 12 months was conducted for 194 babies born to mothers with reactive syphilis serology at delivery, and for two additional children with congenital syphilis diagnosed when they were younger than 1 year (total, 196 children). In the study group, 54 children had reactive FTA-ABS (reactors) until the age of at least 12 months or more, and 142 children had nonreactive FTA-ABS (nonreactors) at the age of 12 months or more. Of the 54 reactors, 17 (31%) had evidence of congenital syphilis at birth, whereas evidence of congenital syphilis was seen in 14 of the 142 (10%) nonreactors (P = 0.0002). At 15 months, nonreactive FTA-ABS developed in six reactors, and eventually in 15 of 44 reactors (34%) tested. A reactive FTA-ABS may be seen at 12 months in children with and without evidence of congenital syphilis at birth. Not all children with congenital syphilis will manifest reactive FTA-ABS at 12 months, and FTA-ABS reactivity wanes with time.

In Utero Infection with Treponema Pallidum in Early Pregnancy

Amniocentesis was performed under sonographic guidance in gravidas (< 20 weeks' gestation) with untreated syphilis. Five to ten millilitres of amniotic fluid from each patient was used for rabbit infectivity testing (RIT) and polymerase chain reaction (PCR) to detect amniotic fluid infection with Treponema pallidum. Gravidas were treated with benzathine penicillin G. Newborns were examined for clinical and laboratory signs of congenital syphilis including immunoglobulin M (IgM) antibody to T. pallidum by Western blotting (immunoblotting). Eleven patients were enrolled at a mean gestational age of 16.8 weeks. T. pallidum was recovered from amniotic fluid by RIT in four cases (36 per cent), and PCR was positive in three of the amniotic fluid specimens (27 per cent). There were no false-positive PCR results. None of the newborns had clinical evidence of congenital syphilis and their sera lacked IgM reactivity to T. pallidum antigens by immunoblotting. These findings confirm in utero infection with T. pallidum in continuing early pregnancy and indicate that in utero treponemal infection can be eradicated by maternal treatment.

Congenital Syphilis Surveillance in Upstate New York, 1989-1992

Descriptive characteristics and clinical information from 322 cases of congenital syphilis were reviewed. The births (318 mothers) included 31 (10%) stillborn and 59 (18%) with clinical evidence of congenital syphilis. Only 60 (19%) had a complete laboratory workup, including radiographs of long bones and spinal fluid analysis. For a subset of 244 women with available information, 218 (89%) had > or = 1 risk factors for syphilis; however, residence in an area with high morbidity from syphilis was the only identified risk factor for 83 (34%). Eighty women (25%) were treated for syphilis during pregnancy; only 24 were treated appropriately for their stage of syphilis > 30 days before delivery. Five of these pregnancies resulted in infants with clinical signs of syphilis. These findings emphasize the need for expanded prenatal screening of high-risk women, the necessity of screening at delivery, and the need for complete evaluation of infants at risk for congenital syphilis. Further, the data suggest that in some cases therapy in the last trimester of pregnancy may be insufficient to adequately treat the fetus.

Serological screening tests for syphilis in pregnancy: results of a five year study (1983-87) in the Oxford region.

Between 1983 and 1987, 62 out of 76519 pregnancies in 51 mothers had a positive miniaturised Treponema pallidum haemagglutination assay (TPHA) test--1 in 1234, or 0.81 per 1000 births. About two thirds of these mothers had syphilis and the remainder non-venereal treponematoses such as yaws or pinta. Antenatal screening identified 13 patients with previously unknown acquired syphilis, 11 of whom were given antibiotics during pregnancy. There were six fetal losses among the 62 TPHA positive pregnancies, but none had evidence of congenital syphilis. No live born child in this study group showed stigmata of congenital syphilis. It is concluded that despite the current low incidence of syphilis in the United Kingdom it is imperative to continue antenatal serological screening and to emphasise the importance of early adequate treatment of the infection.

Third generation infantile syphilis--an unusual presentation

A case of third generation early congenital syphilis with unusual features is reported and discussed. The infant presented with Livedo reticularis and an ulcer on the right forearm since birth; the underlying radius and ulna showed osteomyelitic changes with sequestrum formation and a pathological fracture. The rest of the skeletal system was normal. The blood STS (VDRL) was reactive at 1:64. The child showed no other evidence of congenital syphilis. Livedo reticularis and bony lesions resolved promptly with penicillin therapy, but abnormal movements at the wrist joint persisted. The mother had pathognomic Hutchinsonian incisors and a reactive VDRL test.

先天梅毒に対する形態異常歯の診断的価値に関する研究

It is commonly acknowledged that occurrence in children of certain morphological abnormities of teeth is closely associated with the presence of congenital syphilis in them. Although a great many reports are hitherto available on this problem, most of these were very divergent in either the classification or representation of the abnormities of tooth anatomy, and failed to provide any exact criterion with which one is able to make successful diagnosis. In the present study, a series of oral examination programs was undertaken on a total of 5324 pupils of primary schools, and, based on the eleven dental stigmata hitherto proposed to be involved with congenital syphilis, a group of 29 subjects bearing any one or two such stigmata was gathered out. These subjects were examined for other possible signs of congenital syphilis besides above 11 stigmata to serve for further aid of diagnosis and, based on the serology test as final evidence, diagnostic value of the above 11 stigmata was respectively evaluated. The results were summarized as follows. 1. It was concluded that Fournier's and Hutchinson's teeth proved most reliable for diagnosis of congenital syphilis. 2. Nineteen subjects had Hutchinson's teeth and 18 had Fournier's teeth and when both groups were combined, these members accounted for 29 out of the total children or 0.54% of the total. 3. Eight (31%) out of 29 subjects had both Hutchinson's and Fournier's signs combined. 4. Although no typical instance of Hutchinson's teeth was encountered in the examination of deciduous teeth, similar atypical signs of Hutchinson's stigmata were observed in both permanent and deciduous dentitions, particularly in the lower anterior and upper lateral incisor teeth of the same individuals in whom the manifestation was exceptionally strong. 5. Syphilitic eye disturbances were detected in 11 subjects (0.2%) out of the total children and these subjects accounted for about two third of 29 subjects who had either Hutchinson's or Fournier's teeth or both. 6. A lesser diagnostic value should be assigned to the dwarf teeth as compared to the above two stigmata. 7. About 10% of the teeth with constricted cusps was supposed to be involved in congenital syphilis. 8. Although occurrence of the teeth with a lava-like appearance was very few, results of the serology test administered strongly suggested that such teeth were sure evidence of congenital syphilis. 9. Those manifestations such as Kraupa's symptom (abnormal form of upper lateral incisors), the spiral teeth, mottled teeth, erosion, Carabelli's tubercle and diastema ; these proved of no value for true diagnosis of congenital syphilis.

THE TEETH IN CASES OF CONGENITAL SYPHILIS

The first contribution to medical literature on the subject of dental dystrophies in congenital syphilis was that of Hutchinson, who described the upper central incisors in 1857. He depicted them as being peg-shaped and showing a cresentic notch on their incisal edge. He declared that this deformity was characteristic and was to be considered pathognomonic evidence of congenital syphilis. His views were vigorously contested by Parrot, who saw in them only evidence of rachitis, and by Magitot, who described a similar condition in the jaw of a cow, due to eclampsia. In 1884, Moon described the hypoplastic first molar, which he likewise attributed to congenital syphilis. In 1908, Cavallaro 1 of Florence, Italy, published an extensive article in Dental Cosmos , in which he purports to show that dentification of the first molar begins about the sixth month of fetal life and that of the incisor the first month after birth.