Treatment Of 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.

Persistent syphilitic ocular manifestations despite treatment: a case series

BackgroundPenicillin has remained the most effective treatment for syphilis for several decades. Syphilitic retinal manifestations may persist following treatment and cause visual problems. In this case series, we describe three syphilis patients with persistent posterior segment manifestations due to chronic inflammation, incomplete treatment, and reinfection.Case seriesRecommended initial treatment for all patients was 14 days of intravenous penicillin. Oral prednisone was added 48 h after initiation of penicillin therapy. Case 1: A 48-year-old female presented with gradual vision loss for two months. Fundus imaging revealed syphilitic outer retinopathy (SOR), papillitis, and acute syphilitic posterior placoid chorioretinopathy (ASPPC). After treatment, she had persistent cystoid macular edema (CME) and was treated with intravitreal triamcinolone injections and ketorolac drops. Case 2. A 24-year-old male presented with sudden vision loss for two days. On imaging, he had ASPPC, papillitis, and SOR. IV penicillin treatment was given for 10 days only. He had persistent SOR and was retreated with doxycycline and prednisone. Case 3: A 52-year-old male presented with eye pain and visual loss for one week. There was evidence of ASPPC and papillitis on imaging. One month after treatment, he had persistent papillitis and was restarted on oral prednisone. One year later, he was found to have recurrent ASPPC and was confirmed to be reinfected with syphilis, for which he was retreated.ConclusionWhen treating persistent syphilitic ocular manifestations, we recommend checking that the penicillin treatment was complete and the RPR titers are declining. If both hold true, then the affected eye should be treated with anti-inflammatory therapy. Other factors that contribute to poor visual prognosis include treatment delay, poor initial visual acuity, macular edema, and HIV coinfection.

Epidemiological and clinical aspects of syphilis incidence in the Russian Federation and the Kyrgyz Republic: comparative analysis

The Soviet period of development of domestic dermatovenereology was characterized by scientific achievements and the creation of organizational forms of combating venereal and contagious skin diseases. After the collapse of the USSR, socio-economic changes occurred in the former Soviet republics that affected the medical sphere. In recent years, the integration of dermatovenereologists with representatives of related specialties has increased and cooperation in the exchange of experience between dermatovenereological services of Russia and other countries is actively developing, including in the field of prevention of the spread of STIs. In 2021 and 2022, a significant increase (by 69.7%) in the incidence of syphilis was registered in Russia for the first time compared to 2020, which is due to an increase in this indicator among migrants (from 2801 cases in 2020 to 12748 cases in 2022), of which 30% of syphilis cases were among citizens of Kyrgyzstan. The article presents the results of a retrospective comparative study of syphilis incidence rates among children aged 0 to 14 years, adolescents aged 15 to 17 years, and adults over 18 years in the Russian Federation and the Kyrgyz Republic, and analyzes regulatory documents governing syphilis testing and treatment. Despite significant similarities in approaches to laboratory diagnostics of syphilis, including neurosyphilis, uniform principles of prenatal examination of women and treatment of pregnant women, there are currently a number of significant differences, including shorter courses of therapy and low doses of drugs, shorter periods of clinical and serological monitoring in the Kyrgyz Republic.

Secondary Syphilis Can Simultaneously Mimic Cholestatic Liver Injury and Glomerular Nephropathy

ABSTRACT Syphilis, a disease affecting millions, still poses challenges for men who have sex with men in high-income countries and often presents in varying ways. It is exceedingly rare for syphilis to simultaneously cause an acute liver injury and nephropathy. This case describes the concomitant clinical presentation of these abnormalities and also describes a liver injury that mimicked cholestatic disease. Treatment of syphilis led to complete resolution of the liver and kidney injury. This case demonstrates a need to exclude syphilis in patients with high-risk behaviors who present with cholestatic liver injury in atypical fashions.

Syphilis and pregnancy.

•Although congenital syphilis has a known etiological agent, accessible diagnosis and low-cost, effective treatment with low fetal toxicity, it continues to challenge obstetric and antenatal care services. •The increasing rates of syphilis in the general population have direct repercussions on the increase in cases of congenital syphilis, a situation of objective interest for public health. •Although transforming the recording of syphilis and congenital syphilis into notifiable diseases improved the records and has made it possible to measure the occurrence of these diseases and create solutions, no effects on reducing their frequency have been reached yet. •The failure to control syphilis/congenital syphilis is multifactorial, and associates variables that range from the deficiency in teaching about these diseases in schools and in the training system of the various health professional segments, as well as the lack of rigid policies for quality control from antenatal care until the clinical follow-up of children exposed to Treponema pallidum during pregnancy. •To date, benzathine penicillin is the only antimicrobial accepted as effective by the main health authorities on the planet for the treatment of syphilis in pregnant women. •The fear of anaphylaxis in response to the treatment of syphilis with benzathine penicillin is an important factor hindering the prompt and correct treatment of pregnant women with syphilis, even though health authorities have made efforts to face the problem with solid arguments, still insufficient to resolve the question. •Although specific protocols are published, the failure to control the treatment of syphilis in pregnant women is still observed with high frequency, indicating and reinforcing a failure in the quality control of these care principles. The National Specialized Commission on Infectious Diseases of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo) endorses this document. Content production is based on scientific evidence on the proposed topic and the results presented contribute to clinical practice.

Clinical and laboratory characteristics of asymptomatic and symptomatic neurosyphilis in HIV-infected patients: A retrospective study in China.

There are high rates of human immunodeficiency virus (HIV) and Treponema pallidum coinfection, HIV can increase the incidence and disability rate of neurosyphilis. However, there is a lack of data about the risk factors associated with the development of symptomatic neurosyphilis (SNS). We retrospectively reviewed the medical records of inpatients with concurrent syphilis and HIV infection who underwent a lumbar puncture and completed cerebrospinal fluid (CSF) examination. Sixty inpatients were consecutively enrolled from Beijing Ditan Hospital between January 2015 and March 2023. The clinical and laboratory features were evaluated between the SNS and asymptomatic neurosyphilis (ANS) groups. All patients were male, 25% (15/60) patients were diagnosed with ANS, and 75% (45/60) patients were diagnosed with SNS. Meningovascular neurosyphilis was the most prevalent clinical form in this study. Age, CD4 cell count, highly active antiretroviral therapy use, and serum HIV viral load showed no statistically significant differences between the 2 groups. The SNS group lacked early detection of syphilis (P < .001) and did not get previous adequate therapy for syphilis (P < .001) than the ANS group, as well as a higher initial serum toluidine red unheated serum test (TRUST) titer, current serum TRUST titer, CSF white blood cell count (WBC), protein concentration, and CSF TRUST titer (P = .014, P = .042, P = .01, P = .007, and P = .007, respectively). In multivariable logistic regression, high CSF WBC count (odds ratio = 1.08; P = .032) and previous treatment of syphilis (odds ratio = 0.01; P = .049) related to the SNS. Lack of antisyphilis treatment in the early stage of syphilis and a higher CSF WBC count are related risk factors for SNS in HIV-infected patients. Meningovascular neurosyphilis should get more attention in young patients with cryptogenic stroke.

Local anaesthetic to reduce injection pain in patients who are prescribed intramuscular benzathine penicillin G: a systematic review and meta-analysis

Three to 4-weekly intramuscular injections of benzathine penicillin G (BPG) for a prolonged period (e.g., 10 years, until age 40 years, or lifelong) are recommended for preventing group A streptococcal infections that cause recurrent acute rheumatic fever (ARF) and potential progression to rheumatic heart disease (RHD). The duration of treatment, frequency and local pain associated with BPG injections may lead to reduced compliance. Shorter courses of BPG are recommended for the treatment of syphilis and Streptococcal infections. We aimed to assess the effects of local anaesthesia in reducing injection pain in patients who are being treated with BPG. In this systematic review and meta-analysis, we searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Conference Proceedings Citation Index-Science and LILACS from database inception up to May 4, 2024, and performed additional searches for grey literature. Randomised controlled trials comparing BPG vs. BPG administered alongside local anaesthetics were included. Randomized controlled trials using BPG, irrespectively of indication, and testing any local anaesthetic agent for pain alleviation were considered eligible. We applied GRADE to assess the quality of evidence. Summary data were extracted from included trials. The primary outcome was injection pain, assessed through mean differences. A random-effects model was utilized to account for study heterogeneity. This study is registered with PROSPERO, CRD42022342437. Database searches identified a total of 3958 records, and 3 additional records were retrieved from grey literature searches. After removal of duplicates, screening of abstracts and full-text review, eight trials were included, combining a total of 489 patients (151 patients with RHD). Immediate pain level, as reported by patients, was of high intensity in most studies. Low intensity pain was still reported at 24h. Administration of lidocaine mixed with BPG was associated with a significant reduction in immediate post-injection pain (mean difference-3.84, 95% confidence interval-6.19 to-1.48, P=0.0001; 4 studies; I2=98%; GRADE: moderate quality), pain at 5 min (mean difference-2.85, 95% CI confidence interval-3.78 to-1.92, P<0.0001; 1 study; GRADE: moderate quality), and pain at 20 min (mean difference-1.85, 95% confidence interval-2.61 to-1.09, P<0.0001; 1 study; GRADE: moderate quality) on a 1 to 10 scale. One study assessed lidocaine cream applied to the skin prior to BPG injection and showed no significant reduction in injection pain (mean difference=-0.54, 95% CI confidence interval-1.17 to 0.09, P=0.13; 1 study; GRADE: low quality). Mepivacaine mixed with BPG in patients with syphilis showed a significant reduction of immediate post-injection pain (mean difference-2.19, 95% CI confidence interval-2.49 to-1.89, P<0.0001; 1 study; GRADE: moderate quality). Two studies assessed procaine mixed with BPG and reported: lower immediate pain levels or pain assessed at 1h (mean difference and 95% CI confidence intervals not provided, P=0.001 and P=0.008, respectively; 1 study; GRADE: low quality), or less immediate pain and pain at 24h on the buttock injected with procaine mixed with BPG (mean difference and 95% CI confidence intervals not provided, P<0.001 for both; 1 study; Grade: low quality). No severe adverse reactions were reported. In patients receiving intramuscular BPG injections, moderate quality quantitative evidence suggests that BPG injections diluted with lidocaine or mepivacaine may improve post-injection pain scores compared to BPG injections diluted with sterile water. Procaine may also have a benefit, but quality of evidence was lower. Most studies included small patient samples and assessed pain levels at different timepoints. Due to insufficient data we were not able to assess the impact of injection volume, and local anaesthetics' dose on pain intensity and duration of pain relief. WHO.

Multi-level drivers of congenital syphilis, Oregon, 2013-2021.

Despite the availability of curative penicillin treatment for syphilis during pregnancy, congenital syphilis (CS) cases have surged in the United States, including in Oregon. We conducted a retrospective analysis of individual- and county-level predictors of CS among pregnant people with syphilis in Oregon from 2013-2021. Data were collated from surveillance reports, County Health Rankings, and other sources with upstream county-level data. We used multi-level Poisson regression models to assess associations between CS and individual- and county-level factors. Among 343 people with syphilis during pregnancy, 95 (27.6%) were associated with a case of CS. At the individual-level, a history of injection drug use and a history of corrections involvement were associated with an increased risk of CS, while a recent gonorrhea diagnosis was associated with a decreased risk of CS. County-level violent crime rate, unemployment, income inequality, and adverse childhood experiences increased the risk of CS. Higher county-level socioenvironmental challenges exacerbated CS risk, particularly among people with corrections involvement. Injection drug use, corrections involvement, and county-level socioenvironmental challenges increased CS risk among pregnant people with syphilis in Oregon. Urgent interventions are needed, including innovative care models, policy reforms targeting systemic issues, and enhanced collaboration with community services to address the escalating CS crisis.

Retrospective Cohort Study of Financial Incentives for STI Testing and Treatment in an Outreach Population in Edmonton, Canada, 2018-2019.

The incidence of sexually transmitted infections (STI) continues to increase worldwide. Patient incentives are one proposed intervention to increase STI testing and treatment. We conducted a retrospective cohort study comparing incentivized versus routine care for STI outreach test and treat services between October 2018-June 2019. Incentivized care included a $10 gift card for testing visits and an additional $10 gift card for results and/or treatment visits. Incentivized visits were offered to clients with a lack of housing, who were difficult to locate, or had a history of being lost to follow-up. All test and treatment visits included chlamydia, gonorrhea, syphilis, and HIV testing and/or treatment by Registered Nurses and outreach workers from an STI Clinic. Outreach visits were offered at subsidized housing locations, community-based organizations, and street outreach. From October 2018 to June 2019, 2384 outreach clients were reached: 453 (19.0%) receivedincentives and 1931 (81.0%) received routine care. There were no significant differences in case-finding rates for chlamydia (4.8%), gonorrhea (2.9%), and HIV (0.1%); however, there was for syphilis (3.8% for incentivized vs. 1.9% for routine visits; p = 0.02). All newly diagnosed infections identified in the incentivized group received treatment compared with routine visits (chlamydia 100% vs. 79.1%, p = 0.008, gonorrhea 100% vs. 59.7%, p = 0.002, and syphilis 100% vs. 86.7%, p = 0.08). Incentives were associated with increased case-finding rates of syphilis and were associated with 100% treatment rates. Incentives are a promising approach to decreasing the burden of STI among outreach populations.

A dynamic model and cost-effectiveness on screening coverage and treatment of syphilis included MSM population in the United States

Syphilis is a major sexually transmitted disease, causing a significant public health burden for countries all over the world. Since 2000, there has been a new outbreak of the syphilis epidemic in the United States. Therefore, the prevention and control of syphilis have important research significance. We have established a sex structure and ordinary differential equation model that includes men who have sex with men (MSM). Its epidemiological and biological parameters were obtained by fitting with regional monitoring data from the Centers for Disease Control and Prevention from 1984 to 2014, and the basic reproduction number (R0\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}${\\mathcal{R}_{0}}$\\end{document}) of syphilis is 1.3876. Through cost-effectiveness analysis, we have found that the most cost-effective strategies in the cases of sufficient and insufficient funds are conducting syphilis screening for 50% of sexually active susceptible individuals and conducting syphilis screening for 30% of sexually active susceptible individuals while increasing the treatment rate, respectively. Therefore, in the prevention and control strategies of syphilis, measures such as increasing the coverage rate of syphilis screening for susceptible individuals and simultaneously increasing both the screening coverage rate and the treatment rate are valuable control strategy measures for reference.

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.

Congenital Syphilis - Comprehensive Narrative Review of Alternative Antibiotic Treatment for Use in Neonates.

Congenital syphilis rates increased 10-fold from 2012 to 2022 in the United States. Currently, the therapeutic standard of care is 10 days of intravenous (IV) aqueous crystalline penicillin G, with very limited evidence for alternatives. A long course of IV antibiotic requires hospitalization that is both costly and burdensome for the child and the family. Fortunately, T. pallidum retains susceptibility to other antibiotics based on minimum inhibitory concentrations (MICs). Based on the evidence of safety and efficacy of different antibiotics for use in neonates, ceftriaxone emerges as a potential parenteral candidate and amoxicillin emerges as a potential oral candidate for the treatment of congenital syphilis. Other therapeutic alternatives include cefotaxime (where available), ampicillin, doxycycline, cefixime, and linezolid.

Leber’s Hereditary Optic Neuropathy Following Unilateral Syphilitic Optic Neuritis

This report describes a case of Leber’s hereditary optic neuropathy (LHON) following unilateral syphilitic optic neuritis. A 31-year-old man presented with a four-day history of decreased vision in his left eye. At the initial visit, the patient’s best corrected visual acuity (BCVA) was 1.2 and 0.02 in the right and left eye, respectively, along with a relative afferent pupillary defect in the left eye. Goldmann visual field testing revealed a central absolute scotoma and an enlarged blind spot in the left eye. Serological testing confirmed syphilis with rapid plasma reagin positivity. The patient was diagnosed with syphilitic optic neuritis and treated with intravenous penicillin G (24 million units daily) for two weeks. After two weeks of therapy, his left BCVA improved to 0.4 after two months. However, five months later, despite completing syphilis treatment, the patient developed acute painless visual loss in both eyes. His BCVA decreased to 0.8 and 0.05 in the right and left eyes, respectively. Goldmann visual field testing revealed a central absolute scotoma and an enlarged blind spot in both eyes. After two weeks, BCVA progressively declined to 0.4 in the right and 0.04 in the left eye. Furthermore, Goldmann visual field testing revealed an enlarged central absolute scotoma and blind spot in both eyes. Six months after the initial examination, his BCVA was counting fingers and 0.02 in the right and left eye, respectively. The optic discs appeared diffusely pale in both eyes. Genetic testing for LHON revealed a pathologic mtDNA 11778 point mutation. This case underscores the importance of considering the possibility of LHON if acute or subacute vision loss occurs subsequently or simultaneously in both eyes and remains unresponsive to treatment.

Notification rates for syphilis in women of reproductive age and congenital syphilis in Australia, 2011-2021: a retrospective cohort analysis of national notifications data.

To estimate notification rates for infectious syphilis in women of reproductive age and congenital syphilis in Australia. Retrospective cohort study; analysis of national infectious syphilis and enhanced congenital syphilis surveillance data. Women aged 15-44 years diagnosed with infectious syphilis, and babies with congenital syphilis, Australia, 2011-2021. Numbers and rates of infectious syphilis notifications, by Indigenous status and age group; numbers and rates of congenital syphilis, by Indigenous status of the infant; antenatal care history for mothers of infants born with congenital syphilis. During 2011-2021, 5011 cases of infectious syphilis in women aged 15-44 years were notified. The notification rate for Aboriginal and Torres Strait Islander women rose from 56 (95% confidence interval [CI], 45-65) cases per 100 000 in 2011 to 227 (95% CI, 206-248) cases per 100 000 population in 2021; for non-Indigenous women, it rose from 1.1 (95% CI, 0.8-1.4) to 9.2 (95% CI, 8.4-10.1) cases per 100 000 population. The notification rate was higher for Aboriginal and Torres Strait Islander women than for non-Indigenous women (incidence rate ratio [IRR], 23.1; 95% CI, 19.7-27.1), lower for 15-24- (IRR, 0.7; 95% CI, 0.6-0.9) and 35-44-year-old women (IRR, 0.6; 95% CI, 0.5-0.7) than for 25-34-year-old women, and higher in remote regions than in major cities (IRR, 2.7; 95% CI, 2.2-3.8). During 2011-2021, 74 cases of congenital syphilis were notified, the annual number increasing from six in 2011 to a peak of 17 in 2020; the rate was consistently higher among Aboriginal and Torres Strait Islander infants than among non-Indigenous infants (2021: 38.3 v 2.1 per 100 000 live births). The mothers of 32 infants with congenital syphilis (43%) had not received antenatal care. The number of infectious syphilis notifications for women of reproductive age increased in Australia during 2011-2021, as did the number of cases of congenital syphilis. To avert congenital syphilis, antenatal screening of pregnant women, followed by prompt treatment for infectious syphilis when diagnosed, needs to be improved.

Lack of Serological Response by Delivery to Syphilis Treatment Does Not Impact Pregnancy Outcomes.

Objectives: Maternal syphilis can lead to serious adverse pregnancy outcomes, including neonatal death. A 4-fold decline in blood non-treponemal titer at six months after the treatment of syphilis compared to the baseline is considered as an adequate serological response. However, the duration of normal human gestation does not allow the ascertainment of an adequate serological response. Aim: The aim of this study was to assess correlations between the lack of a 4-fold decrease in non-treponemal titer by delivery after syphilis treatment and fetal and newborns' condition and serological outcomes. Methods: Fourteen pregnant patients (gestational age 16-22 weeks) diagnosed with early syphilis (secondary or latent) were treated with intramuscular benzathine penicillin and subsequently monitored clinically, serologically, and ultrasonographically at monthly intervals. Based on the non-treponemal test results at delivery, patients were stratified into two groups: those with a 4-fold decline in titers and those without such a decline. All newborns were clinically and serologically assessed for congenital syphilis at birth and then monitored until serological tests became negative. Results: Fifty percent of the included women did not achieve a 4-fold decline in non-treponemal titer by delivery. Patients from the group showing a 4-fold decline in RPR titer at delivery and those without such a decline did not differ in basic demographic and clinical characteristics or in ultrasound parameters used for fetal assessment. Based on the clinical and laboratory assessments of newborns on the day of delivery and during a 6-month follow-up, none were diagnosed with congenital syphilis or required treatment for syphilis. Conclusions: The lack of an adequate serological response to syphilis therapy by delivery among patients treated between 16 and 22 weeks of pregnancy does not appear to be associated with adverse fetal and neonatal outcomes.

A Review of Syphilis Infection in Pediatric Patients

Nearly half of all sexually transmitted infections occur in adolescents and young adults. Among them, syphilis infections are on the rise in the United States. Sexually active adolescents, especially those who do not use condoms consistently or are men who have sex with men, are at particular risk for syphilis infection. With the rise in acquired syphilis infections, the incidence of congenital syphilis has also increased. Syphilis can have a variety of presentations based on infectious stage and central nervous system involvement. Careful physical examination and history can elicit the diagnosis. Screening with a nontreponemal test followed by treponemal testing can confirm the diagnosis, and staging is determined clinically. Testing for all sexually transmitted infections should be pursued because coinfections are common. Penicillin is the first-line treatment for syphilis, and duration of therapy depends on the presence of neurologic symptoms; all infants with possible congenital syphilis should receive treatment. Posttreatment monitoring is essential to confirm successful eradication of syphilis. All sexually active, at-risk patients, including pregnant persons, should be screened for syphilis, and those diagnosed as having syphilis should be counseled on disclosure to partners. Although not often found in a pediatric population, with the increasing incidence of syphilis infections in the United States, pediatric providers should have a low threshold for syphilis screening in adolescents and a high index of suspicion for congenital syphilis in infants.

Factors associated with signs of congenital syphilis in newborns

ObjectiveTo analyze risk factors (maternal, obstetric and demographic) associated with congenital syphilis and the clinical characteristics of the newborns. MethodA cross-sectional study carried out in ten public maternity hospitals in Fortaleza, Ceará, Brazil that included cases of live births reported with congenital syphilis in 2015. Results469 cases were analyzed; 199 (42.4 %) showed some sign or symptom suggestive of congenital syphilis; of these, 65 (32.7 %) were preterm, 87 (43.7 %) had low birth weight, 116 (58.3 %) had jaundice that required phototherapy, 13 (6.5 %) had hepatomegaly, 10 (5 %) had skin lesions, eight (4.0 %) had splenomegaly and one (0.5 %) had limb pseudoparalysis. Records of other clinical changes were identified in 36 (7.7 %) children. Children whose mothers were not treated or who received a drug other than penicillin and those whose mothers had a VDRL titer ≥ 1:16 at birth were 3.7 and 3.2 times more likely to be born with signs of congenital syphilis (p < 0.001- 95 % CI 2.41–5.58; p < 0.001 – 95 % CI 2.41–5.58) respectively. ConclusionsThe findings of this study draw attention to the importance of improving the quality of prenatal care and the development of studies aimed at finding alternative drugs for the treatment of syphilis in pregnant women and the prevention of congenital syphilis.

Doubts about the diagnosis and treatment of syphilis in pregnancy among primary care professionals in a telehealth service

Doubts about the diagnosis and treatment of syphilis in pregnancy among primary care professionals in a telehealth service

The Obsolescence of Azithromycin for Syphilis Treatment and the Value of Contrasting Different Types of Evidence.

The Obsolescence of Azithromycin for Syphilis Treatment and the Value of Contrasting Different Types of Evidence.

Congenital Syphilis: A Re-Emerging but Preventable Infection.

Congenital syphilis presents a significant global burden, contributing to fetal loss, stillbirth, neonatal mortality, and congenital infection. Despite the target established in 2007 by the World Health Organization (WHO) of fewer than 50 cases per 100,000 live births, the global incidence is on the rise, particularly in low- and middle-income regions. Recent data indicate a rate of 473 cases per 100,000 live births, resulting in 661,000 total cases of congenital syphilis, including 355,000 adverse birth outcomes such as early fetal deaths, stillbirths, neonatal deaths, preterm or low-birth-weight births, and infants with clinical congenital syphilis. Alarmingly, only 6% of these adverse outcomes occurred in mothers who were enrolled, screened, and treated. Unlike many neonatal infections, congenital syphilis is preventable through effective antenatal screening and treatment of infected pregnant women. However, despite available screening tools, affordable treatment options, and the integration of prevention programs into antenatal care in various countries, congenital syphilis remains a pressing public health concern worldwide. This review aims to summarize the current epidemiology, transmission, and treatment of syphilis in pregnancy, as well as to explore global efforts to reduce vertical transmission and address the reasons for falling short of the WHO elimination target.