Treatment Of Congenital Syphilis Research Articles

Evaluation and Treatment of Congenital Syphilis: A National Survey of US Pediatric Specialists.

Background/Objectives: As congenital syphilis incidence continues to increase yearly in the United States (US), recommendations from government and professional organizations aim to inform effective clinical practice, although it is unclear how closely these recommendations are followed. This study surveyed US pediatric specialists regarding their approach to congenital syphilis diagnosis and treatment to examine decision-making relative to practice guidelines and subspecialty. Methods: US pediatric physicians recruited from subspecialty directories were sent an online survey conducted in March-April 2024. The case-based survey elicited diagnostic and treatment decisions for different case definitions of congenital syphilis (proven or highly probable, possible, and less likely). Results: Among 442 respondents (56.8% women, 74.2% age 40-69, 57.7% 15+ years since training completion), 94.1% chose to evaluate and manage proven or highly probable congenital syphilis as recommended whereas only 45.8% did so for congenital syphilis considered less likely. Diagnostic and treatment decisions by infectious disease specialists and other subspecialists differed across case definitions. Conclusions: Physicians' approaches to congenital syphilis workup and management, including the decision to treat, varied with case presentation where decision-making seemed to diverge from published recommendations and between subspecialists as infection became less likely by case definition.

The Role of Pediatric Pharmacists in the Prevention and Treatment of Congenital Syphilis.

In recent years, rates of syphilis in adults have been on the rise resulting in an increase in the number of neonates born with congenital syphilis. National organizations including the Centers for Disease Control and Prevention as well as The US Preventative Services Task Force recommend routine testing of pregnant persons to identify and provide maternal syphilis treatment prior to delivery. Significant variability exists between states for these screenings, resulting in some pregnant persons not being diagnosed prior to delivery. The Pediatric Pharmacy Association (PPA) believes that pharmacists, along with other health care providers can help by ensuring optimal syphilis testing and treatment pathways for pregnant individuals and newborns are included in their workplaces. PPA also supports pharmacists working to increase treatment compliance by providing medication education and counseling regarding optimal treatment of syphilis infections, as well as work with state and local governments to standardize treatment recommendations.

Guidelines on Gestational and Congenital Syphilis: insights of health professionals in Bolívar (Colombia)

To describe the knowledge, appropriateness and practices regarding the evidence-based “Clinical Practice Guidelines (CPG) for the comprehensive management of gestational syphilis (GS) and congenital syphilis (CS)”. A descriptive, cross-sectional study including general practitioners, specialists and nurses working at 52 healthcare institutions in the Bolivar Department (Colombia) who provided prenatal control or neonatal care in 2020. Convenience sampling was used. A digital questionnaire was administered to collect sociodemographic information, assessed knowledge, appropriateness and practices in terms of the evidenced-based “Clinical Practice Guidelines (CPG)" mentioned in the objectives. A descriptive analysis followed. A total of 101 workers were included. There are deficiencies associated with the correct use of the inverse algorithm of diagnosis (48 %) and GS followup (77 %), management of the patient with a history of systemic manifestation allergies (31 %) and treatment of GS (61 %) and CS (10 %). The recommendation of not using the penicillin test in patients with no history of systemic allergies is considered of little benefit (60 %). 23 % of the workers do not use rapid tests and 44 % of the specialists administer syphilis treatment to the sexual partner. It is important to intensify the training strategies for health personnel with emphasis on nurses and, as a matter of urgency, empower them in syphilis control activities. New and continuous national and regional evaluations of the implementation of these guidelines are needed to assess the indicators associated with the strategy for the elimination of this disease.

1619. Epidemiology of Congenital Syphilis Infections in Northwestern (NW) Iowa Witnessing a Significant Increase- Experience of a Tertiary Care Center

Abstract Background According to the CDC, STI (sexually transmitted infections) including syphilis infections in adults have recently increased in the upper Midwest. Studies evaluating epidemiology of Congenital syphilis (CS) are needed to facilitate prompt recognition to prevent sequelae. Methods We retrospectively studied epidemiologic, clinical characteristics and outcomes of neonates with CS at our tertiary care center which is the largest maternal/neonatal center in NW Iowa during 1/1/2021-12/31/2022 (labeled P2). Epidemiologic characteristics during P2 were compared with the period from 1/1/2019-12/31/2020 (labeled P1). Diagnosis and treatment for CS were in accordance with CDC/American Academy of Pediatrics Committee on Infectious Diseases Red Book guidelines. Results During P2, a total of 42 newborns were diagnosed with CS compared to 0 during P1 (p< 0.05); 64% of infected newborns were White followed by Native American (21%), Hispanic (11%) and Black (2%). All (100%) neonates with CS were born to mothers infected during or after second trimester of pregnancy with negative first trimester RPR (Rapid Plasma Reagin) testing. Maternal RPR titers ranged from 1:1-1:256. Majority (62%) of newborns were diagnosed with proven/possible CS with RPR-titers > 4-fold mother's titers /untreated or inadequately treated maternal infection and required 10 days of intravenous Aqueous crystalline penicillin G treatment and NICU care; 2 newborns had meningitis and 3 developed sensorineural hearing loss. Thirty-eight% received 1 dose of intramuscular Benzathine penicillin G. Need for cerebrospinal fluid syphilis testing and 10 days of intravenous penicillin treatment increased by > 600% from P1 to P2 (p=0.02). CS evaluation/treatment in infected Native American neonates increased by > 1000% in P2 (p< 0.001). Mean hospitalization duration was 9.5 (±1.6) days. No infant died. Only 33% of infants followed up at 2 months for repeat testing. None of the Native American/Hispanic/Black neonates compared to 52% White neonates had follow-up testing (p< 0.05). Conclusion Our results show an alarming increase in CS in NW Iowa and underline the need for urgent preventive measures including STI prevention education, adequate maternal/ neonatal testing and follow-up, especially among marginalized populations. Disclosures All Authors: No reported disclosures

Varied Clinical Presentations of Congenital Syphilis in Infants: A Case Series of 7 Cases

Congenital Syphilis (CS), also known as mother-to-child transmission of syphilis is caused by Treponema pallidum. Infected pregnant women can transmit the infection vertically to the foetus. Diagnosis of CS can be difficult because more than two-thirds of affected infants remain asymptomatic at birth, and signs may be non-specific or subtle. In this case series, seven cases of CS with varied presentations are described. In cases 1, 2, 6, mothers were screened after the baby was tested positive for Venereal Disease Research Laboratory (VDRL) test. In two cases (Case-4,6), the mothers received inadequate treatment for syphilis antenatally. In the present case series, Case-6 presented with renal manifestations early in the course of the disease, Case-2 had skin manifestations like vesicular lesions and peeling of skin and Case-7 had symptoms suggestive of meningitis. Because of its varied presentations, high index of suspicion is the key to diagnosis and treatment of CS and prognosis. Screening of pregnant women and treating them is the most effective way in preventing CS and its related morbidity and mortality.

Congenital Syphilis Epidemiology, Prevention, and Management in the United States: A 2022 Update.

Congenital syphilis (CS) has dramatically increased in the United States (US) in the past decade despite the widespread availability of penicillin.Once considered an infection on the verge of elimination, CS has re-emerged as a familiar neonatal pathogen in US hospitals. This rise in cases has prompted the evaluation of potential causes and updates in prevention and management guidelines.Following a structured narrative approach, we reviewed CS data reports, peer-reviewed research articles, and updated management guidelines from state health departmentsover the past two decades. Our main search criteria centered on the treatment and prevention of CS, with a focus on prenatal health disparities. We identified geographical regions reporting disproportionate rates of CS, examined state laws regarding maternal syphilis testing, and evaluated potential reasons for the recent rise in cases. This article examines the current epidemiology, screening, and management recommendations for perinatal and CS in the US.It also reviews pathogenesis and clinical features in perinatal and pediatric populations. Finally, it highlights the likely contributing factors to increased CS rates and identifies areas for future research. Dramatically rising CS cases in certain regions and racial groups reflect gaps in the prevention, timely diagnosis, treatment, and management of perinatal syphilis and CS. Healthcare providers attending to mothers and children should recognize the re-emergence of this pathogen and be familiar with new screening and management guidelines.Increased federal funding for targeted interventions and research that address vulnerable populations is critical to curbing the re-emergence of this infection.

Congenital Syphilis : Still a Reality in Bangladesh

Congenital syphilis is caused by Treponema Pallidum. The fetus can acquire it transplacentally during maternal spirochetemia, or contact with genital lesion during the intrapartum period. The prevention and treatment of congenital syphilis are very much cost-effective, but if it remains undiagnosed and untreated, can result in a deadly outcome. It can affect multiple organs and systems. In this present case, skeletal systems were predominantly involved. The clinical presentation was the failure to gain weight, painful mobilization of the right arm, and swelling of the proximal and distal end of this arm. Erythematous, maculopapular scaly skin eruption was also noticed in the scalp and scrotum. Radiological examination showed metaphyseal irregularity, and periosteal reaction at the right humerus, radius, and ulna. Nontreponemal antibody test (VDRL) and a treponemal antibody test (TPHA) both were reactive. Early congenital syphilis may have a subtle clinical presentation or may remain asymptomatic. Therefore physicians should aware of the clinical presentation of congenital syphilis; at the same time, detailed clinical history can play an important role to suspect congenital syphilis. Promotion of pregnant women for antenatal care and screening for syphilis in the first trimester are the keys to eliminating congenital syphilis.
 Chatt Maa Shi Hosp Med Coll J; Vol.21 (1); January 2022; Page 73-77

Better care for babies: the added value of a modified reverse syphilis testing algorithm for the treatment of congenital syphilis in a maternity Hospital in Central African Republic

BackgroundIn high syphilis prevalence settings, the syphilis testing and treatment strategy for mothers and newborns must be tailored to balance the risk of over treatment against the risk of missing infants at high-risk for congenital syphilis. Adding a non-treponemal test (Rapid Plasma Reagin - RPR) to a routine rapid treponemal test (SD Bioline Syphilis 3.0) for women giving birth can help distinguish between neonates at high and low-risk for congenital syphilis to tailor their treatment. Treatment for neonates born to RPR-reactive mothers (high-risk) is 10 days of intravenous penicillin, while one dose of intramuscular penicillin is sufficient for those born to RPR non-reactive mothers (low-risk). This strategy was adopted in March 2017 in a Médecins Sans Frontières supported hospital in Bangui, Central African Republic. This study examined the operational consequences of this algorithm on the treatment of newborns.MethodsThe study was a retrospective cohort study. Routine programmatic data were analysed. Descriptive statistical analysis was done. Total antibiotic days, hospitalization days and estimated costs were compared to scenarios without RPR testing and another where syphilis treatment was the sole reason for hospitalization.ResultsOf 202 babies born to SD Bioline positive mothers 89 (44%) and 111(55%) were RPR-reactive and non-reactive respectively (2 were unrecorded) of whom 80% and 88% of the neonates received appropriate antibiotic treatment respectively. Neonates born to RPR non-reactive mothers were 80% less likely to have sepsis [Relative risk (RR) = 0.20; 95% Confidence interval (CI) = 0.04–0.92] and 9% more likely to be discharged [RR = 1.09; 95% CI = 1.00–1.18] compared to those of RPR-reactive mothers. There was a 52%, and 49% reduction in antibiotic and hospitalization days respectively compared to a scenario with SD-Bioline testing only. Total hospitalization costs were also 52% lower compared to a scenario without RPR testing.ConclusionsThis testing strategy can help identify infants at high and low risk for congenital syphilis and treat them accordingly at substantial cost savings. It is especially appropriate for settings with high syphilis endemicity, limited resources and overcrowded maternities. The babies additionally benefit from lower risks of exposure to unnecessary antibiotics and nosocomial infections.

Congenital Syphilis Rates Correlate With Increased Maternal Syphilis Rates in a New Orleans Tertiary Care Center [30I

INTRODUCTION: In recent years, the number of congenital syphilis (CS) cases in the United States increased from 8.4 to 11.6 cases per 100,000 live births. In 2017, Louisiana reported the highest rates of CS in the country. This study aims to determine provider management patterns for newborns at risk for CS. METHODS: All cases of maternal syphilis from 2013-2017 at Touro Infirmary in New Orleans, LA were identified using ICD-9 and ICD-10 codes. Women who were serofast were excluded. Seventy-three mother child pairs were identified with available records. Charts were reviewed for stage of syphilis, treatment regimen during pregnancy, interval from treatment to delivery and other variables. Newborn information including neonatal intensive care unit (NICU) admission, physical and radiologic exam findings, nontreponemal titers, treatment regimen and other outcomes were recorded. Variables were summarized using means with standard deviations and frequencies expressed as percentages. RESULTS: Of the 73 newborn charts reviewed, 8.96% (n=6) were found to be symptomatic, however only 83.3% of them were admitted to the NICU. Only 29.6% of infants were adequately treated with an extended penicillin regimen if the mother did not receive appropriate treatment. Furthermore, only 63.0% of newborns had a nontreponemal titer performed. Only twenty six percent (n=16) of asymptomatic newborns (n=61) considered low risk for CS received single dose penicillin. CONCLUSION: With the rising rates of both maternal and CS, strict adherence to the CDC guidelines for treatment of CS must be maintained. Attention to maternal treatment guidelines and vigilant follow up are necessary to ensure treatment success.

Antibiotic treatment for newborns with congenital syphilis.

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. To assess the effectiveness and safety of antibiotic treatment for newborns with confirmed, highly probable and possible congenital syphilis. 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. 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. 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. 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. 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.

A Rare Case of Congenital Syphilis and a Supernumerary Fourth Molar in an Early 20th Century African American Woman

Congenital syphilis is a disease recognized for interfering with odontogenesis, producing specificdental characteristics including Hutchinson’s incisor, Moon’s molar, Fournier’s molar and mulberry molar,while its past treatments including mercury are known to affect amelogenesis. Supernumerary teeth, mainly associatedwith syndromes, are not commonly found in cases of congenital syphilis. A rare case of congenitalsyphilis in an individual (P000707) treated with mercury and a mandibular left fourth molar with normal morphologyis presented.Materials and Methods: During a systematic examination of 28 skeletons with treponemal disease at the Smithsonianmuseum in Washington, DC, a supernumerary mandibular distomolar in one individual (P000707) wasrevealed.Results: P000707 was an African American female, 26 years of age. Dentition showed severe enamel hypoplasiaof the maxillary and mandibular incisors, left canine, and upper first molars, consistent with the effects of treatmentof congenital syphilis by mercurial compounds. Crown of the left mandibular distomolar has typical molarmorphology but is smaller in size than other permanent molars. Arrangement of grooves resembles the +4 pattern,but is complex due to crenulation. Oblique x-ray revealed that the fourth molar had one root with a pulpchamber extending towards the apex, suggesting taurodontism. No other distomolar teeth were present.Conclusions: Congenital syphilis and treatment containing mercury may not influence the development of supernumeraryteeth due to: (1) the age at which the development of the fourth molar takes place, (2) the stage ofthe infection at the time of development and (3) the age at which treatments containing mercury are administeredto patients with congenital syphilis.

The amount of penicillin needed to prevent mother-to-child transmission of syphilis.

Syphilis is unique among sexually transmitted diseases in that it remains curable (with minimal reports of resistance) with a single dose of penicillin, formulated for this purpose as long-acting benzathine penicillin.1,2 Pregnant women with untreated syphilis experience adverse birth outcomes in over half of untreated pregnancies. These outcomes include stillbirth, organ deformities, prematurity and neonatal death.3 The World Health Organization (WHO) estimates that 930 000 pregnant women have probable active syphilis (transmissible during pregnancy) annually which results in approximately 350 000 adverse birth outcomes per year.4 Most maternal syphilis cases and adverse pregnancy outcomes occur in low- and middle-income countries, and more than half occur in sub-Saharan African countries.4 WHO estimates that global syphilis prevalence is 0.5% (95% uncertainty interval, UI: 0.4–0.6%) which corresponds to a global incidence of 5.6 million (95% UI: 4–8 million) syphilis cases per year among people aged 15–49 years.5 From these estimates, it is possible to calculate the amount of penicillin needed for syphilis treatment on a global scale. However, the difference between the global needs and what is currently produced is not possible to quantify as there is no global monitoring of availability. In May 2016, benzathine penicillin was recognized by the 69th World Health Assembly as an essential medicine that has been in short supply for several years. These shortages have affected treatment and prevention of congenital syphilis.6 A lack of benzathine penicillin can result in pregnant women with syphilis receiving ineffective or no treatment.7–10 Benzathine penicillin is a generic injectable with very few global manufacturers and is therefore at high risk for inventory stock out and shortages at the point-of-care. WHO has received reports of stock outs of benzathine penicillin from antenatal care representatives and providers in high morbidity countries from three WHO regions.11 Shortages during 2015 and 2016 at the manufacture and supply levels have been reported in the region of the Americas.12–14 An estimated 5.6 million doses of 2.4 million units of benzathine penicillin are needed annually to treat all syphilis cases.5 Of these, 930 000 doses are needed to treat pregnant women with syphilis early in pregnancy to prevent all cases of congenital syphilis.4 These separate estimates indicate an acute need for expanded access to benzathine penicillin in countries with high rates of adult syphilis and ongoing improvements in syphilis screening during antenatal care. WHO advocates use of these estimates in discussions at the manufacture and distribution levels to ensure a reliable supply of benzathine penicillin in all countries with cases of adult syphilis. Global demand for this formulation of penicillin has not been consistently and adequately quantified. Many people with syphilis do not develop pathognomic signs or symptoms and do not receive a diagnosis because they are unaware of infection or are unable to access health care and/or diagnostic tests. Therefore, these estimates of penicillin requirements are greater than the number of adults who will have been diagnosed with syphilis. These estimates do not include the treatment of congenital syphilis in infants as such regimens require different doses of aqueous, procaine, or benzathine penicillin formulations.1,2 As a result of increasing need and reported shortages, and in response to the directives from the 69th World Health Assembly, WHO, in partnership with other stakeholders, is doing a market analysis that will include evaluation of production, demand, supply and procurement practices at manufacture, country and regional levels. Results of this analysis will be used to further refine estimates of benzathine penicillin demand, improve availability and develop interventions to improve supply management and procurement. WHO’s plan for the elimination of mother-to-child transmission of HIV and syphilis includes targets of 95% of pregnant women receiving antenatal care and receiving syphilis testing during antenatal care, and 95% of women diagnosed with syphilis during pregnancy being treated.15 Elimination targets for syphilis are achievable given that benzathine penicillin, the only recommended treatment for syphilis occurring in pregnant women, can cure maternal syphilis and prevent adverse birth outcomes related to congenital syphilis if provided early in pregnancy.1,2 Countries seeking to expand and improve prenatal care, reduce adverse pregnancy outcomes, and achieve congenital syphilis elimination targets must have access to a secure supply of benzathine penicillin. Equally, manufacturers need a reasonable global needs estimate as part of the business case required to justify any changes to their manufacturing processes. These WHO estimates of penicillin needs can be used along with estimates of demand to adapt manufacturing practices to expand access to benzathine penicillin.

Microcalcificaciones cerebrales en un recién nacido con tuberculosis congénita

Tuberculosis is a serious public health problem worldwide. In 2012, the World Health Organization estimated 8.6 million new cases and 1.3 million deaths due to the disease. In 2011, the incidence in Colombia was 24 cases per 100,000 inhabitants. There is little information about tuberculosis in pregnant women, and congenital infection is considered a rare disease that is difficult to diagnose, leads to high mortality, and may be confused with tuberculosis acquired after birth. In addition, it has been associated with HIV infection in mothers and infants. Moreover, there is increasing incidence of congenital syphilis in the world. In Colombia, the prevalence is 2.5 cases per 1,000 births and its frequency in the Instituto Materno Infantil-Hospital La Victoria is one case per 57 births. We report the case of a newborn under treatment for congenital syphilis and in whom microcalcifications were found in a transfontanelar ultrasound. This finding warned about the existence of another infectious agent. PCR was negative for cytomegalovirus, and IgM titers for toxoplasma, rubella and herpes I and II were also negative.After learning about a history of incomplete treatment for tuberculosis in the mother, we suspected the presence of an infection by the tubercle bacillus in the newborn. No acid-fast bacilli were demonstrated in three gastric juice samples. The IS6110 PCR assay was found positive in cerebrospinal fluid and urine, but not in blood. The newborn was treated with crystalline penicillin for 10 days along with isoniazid, rifampicin, pyrazinamide and streptomycin. The patient is currently under clinical monitoring.

A review of the guidelines for the evaluation and treatment of congenital syphilis.

Congenital syphilis (CS) is a disease that continues to persist in the United States despite its preventable nature. Mother-to-child transmission of CS can be avoided with appropriate maternal diagnosis and treatment during the pregnancy. Diagnosing CS and determining the therapeutic course can be challenging. This review covers the recent guidelines for the diagnosis and treatment of CS and the various factors that affect management decisions. These factors include the mother's antenatal management, the infant's clinical presentation and results, laboratory and serologic testing, and more.

Missed Opportunities for Preventing Congenital Syphilis Infection

To the Editor: Louisiana has experienced high and increasing rates of congenital syphilis (CS) since 2005.1 Using data from Louisiana’s Office of Public Health Sexually Transmitted Disease/HIV Program’s electronic investigation and reporting system, we reviewed data for all patients with CS born from January 1, 2010 to October 6, 2011. Similar to other recent US reports, we found women with documented prenatal care who did not receive recommended testing or treatment for syphilis.2 Fifty-five women gave birth to 57 infants identified as CS cases by the Louisiana Sexually Transmitted Disease/HIV Program; cases can be identified based on a mother’s history of untreated syphilis or findings in the infant.1 This corresponds to 51.9 cases per 100,000 births.3 Thirty-six women (65%) had documented prenatal care before 30 weeks of gestation. Of those 36, 4 (11%) had documented adequate treatment for syphilis before pregnancy, and 19 (53%) had adequate maternal treatment during pregnancy. Among those 23, 3 women had infants with abnormal evaluations. The remaining 20 women had infants who were classified as CS cases due to maternal serology or reasons that are unclear. Five (14%) of the 36 received penicillin-based treatment less than 30 days before delivery, and 8 (22%) had no treatment documented. No woman received non–penicillin-based treatment. Of the 8 women with no treatment documented, 1 had a positive syphilis test result 5 months before delivery, and 6 had their first positive test result at delivery or within 1 month of delivery, without documentation of prior negative test results. Only 1 untreated woman who tested positive at delivery had a documented negative syphilis test result at her first prenatal visit. The 5 women who received late treatment, together with the 7 women with no treatment who were tested late in pregnancy, represent 12 missed opportunities to prevent CS in Louisiana in less than 2 years. Documented infant evaluation was often incomplete, and some infants did not receive treatment. Twenty-three infants (40.3%) had a documented cerebrospinal fluid Venereal Disease Research Laboratory test, and 3 (13%) were positive. Seventeen infants (29.8%) had a documented cerebrospinal cell count/protein, and 12 (70.6%) had abnormal results. Twenty-three infants (40.3%) had documented bone radiographs, and 1 (4.3%) had an abnormal result. Three infants (5.3%) had unspecified clinical manifestations of CS documented on physical examination. Six infants (10%) were documented to have no treatment for CS during their hospitalization. Our analysis was limited to data in Louisiana’s electronic investigation and reporting system, and it is possible that clinical care occurred that was not documented by the public health workers. Congenital syphilis is preventable with quality, timely prenatal care. Although screening and treating women who do not present for prenatal care is a major challenge, providing appropriate care to those who do present is imperative. The Centers for Disease Control and Prevention, the American College of Obstetrics and Gynecologists, and the American Academy of Pediatrics recommend universal syphilis screening of pregnant women at the first prenatal visit and repeat screening in the third trimester and at delivery in high-morbidity areas.4 By working together, health departments and providers can ensure that these guidelines are followed and that pregnant women are treated for syphilis rapidly and appropriately to prevent CS infections. Camille E. Introcaso, MD Heather Bradley, PhD Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA [email protected] DeAnn Gruber, PhD Louisiana Office of Public Health STD/ HIV Program, New Orleans, LA Lauri E. Markowitz, MD Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA

EpidEmiological analysis of congEnital syphilis in thE statE of cEará, Brazil

Introduction: congenital syphilis is a systemic infectious disease of chronic evolution caused by the Treponema pallidum bacterium dissemination to the fetus through the placenta of infected pregnant women untreated or treated improperly, occurring at any stage of pregnancy or clinical stage of the disease. Objective: epidemiological analysis of congenital syphilis in the State of Ceara from 2007 to 2010. Methods: documentary study conducted in March, 2013, through the database available at the Center for Information and Analysis in Health which keep the information about the National System of Notifiable Diseases records. There were 1,577 notifications of congenital syphilis cases. Results: the following results were observed: 71.78% (n = 1,132) of women who had their children diagnosed with congenital syphilis attented to prenatal consultation; 46.16% (n = 728) had a diagnosis of syphilis identified only during delivery/curettage; about 69.5% (n = 1,096) of pregnant women partners did not undergo any treatment for congenital syphilis. It was noted that over 90% of children were diagnosed with congenital syphilis until the sixth day of birth, and the most prevalent final classification was recent syphilis with 83.83% (n = 1,322) of cases. The most common clinical evolution for children had a favorable outcome, as more than 75% of them underwent treatment and remained alive during the studied period. Conclusion: the thorough analysis of congenital syphilis cases and the factors involved in the process are of fundamental importance to support the actions to prevent and control the disease.

Resurgence of Congenital Syphilis: Diagnosis and Treatment

Despite comprehensive antenatal screening recommendations and inexpensive treatment, congenital syphilis has long been and continues to be a public health concern, causing substantial morbidity and adverse outcomes. The following article reviews syphilis etiology and presentation, clinical disease, laboratory diagnosis, and treatment of congenital syphilis. A case will be presented describing a 31-week male infant exposed to infectious syphilis in utero. The neonate presented with classic signs of infection at birth. After initial serology testing of the infant, appropriate treatment was commenced. The infant received crystalline penicillin G for a period of ten days in consultation with pediatric infectious disease specialists. As expected, the infant's rapid plasma reagin (RPR) titers declined by three and six months of age. An interdisciplinary approach provided safe and optimal care for this infant. He was discharged, stable, and thriving at 38 weeks corrected age. Long-term multidisciplinary management and follow-up were arranged.

Syphilis congénitale : à propos d’un cas

Syphilis is a re-emerging infectious disease in Western Europe. Congenital syphilis is a potentially serious pathology affecting newborns of infected mothers. This disease is easily curable by a simple antibiotic treatment. Because of systematic antenatal screening it should no longer exist in industrialized countries. Nevertheless, we report a case of a six-week-old infant with a delayed diagnosis of congenital syphilis. Physicians, especially gynaecologists, obstetricians and paediatricians, have to be vigilant in order to allow for early diagnosis and appropriate treatment of congenital syphilis.

Liver Function in Early Congenital Syphilis

In this prospective study, neonates with clinical congenital syphilis were investigated to determine if penicillin therapy caused a deterioration in liver function. The relationship between circulating immune complexes and liver involvement was monitored, and the efficacy of steroid therapy as an adjunct in the treatment of congenital syphilis was investigated. Thirty neonates with clinical congenital syphilis were randomly assigned into two groups: one group received penicillin therapy only, and the other group penicillin and prednisone as an adjunct. Twenty-one infants who did not have clinical or serological syphilis, born to seropositive mothers, served as a "control" group. Liver function tests, full blood counts, and immunological studies were performed at various intervals up to 3 months of age. Although the symptomatic groups differed significantly from the asymptomatic group in most of the parameters measured, there were no significant differences noted between the two symptomatic groups at any time point. No direct relationship between penicillin therapy and either deteriorating liver function or the presence of circulating immune complexes could be demonstrated. Also, prednisone therapy did not modify any of the parameters studied.

Liver Function in Early Congenital Syphilis

SummaryIn this prospective study, neonates with clinical congenital syphilis were investigated to determine if penicillin therapy caused a deterioration in liver function. The relationship between circulating immune complexes and liver involvement was monitored, and the efficacy of steroid therapy as an adjunct in the treatment of congenital syphilis was investigated. Thirty neonates with clinical congenital syphilis were randomly assigned into two groups: one group received penicillin therapy only, and the other group penicillin and prednisone as an adjunct. Twenty‐one infants who did not have clinical or serological syphilis, born to seropositive mothers, served as a “control” group. Liver function tests, full blood counts, and immunological studies were performed at various intervals up to 3 months of age. Although the symptomatic groups differed significantly from the asymptomatic group in most of the parameters measured, there were no significant differences noted between the two symptomatic groups at any time point. No direct relationship between penicillin therapy and either deteriorating liver function or the presence of circulating immune complexes could be demonstrated. Also, prednisone therapy did not modify any of the parameters studied.