Syphilis:

          Caused By Treponema pallidum (spirochete)
          Transmitted via sexual contact
          Placental transmission as early as 6wks gestation
          Typically occurs during second half
          Mom with primary or secondary syphilis is more likely to transmit than latent disease
          Large decrease in congenital syphilis since late 1990s
          In 2002, only 11.2 cases/100,000 live births reported

Congenital Syphilis

          2/3 of affected live-born infants are asymptomatic at birth
          Clinical symptoms split into early or late (2 years is cutoff)
          3 major classifications:
          Fetal effects
          Early effects
          Late effects

Clinical Manifestations

Fetal:
          Stillbirth
          Neonatal death
          Hydrops fetalis
          Intrauterine death in 25%
          Perinatal mortality in 25-30% if untreated

Early congenital (typically 1st 5 weeks):

          Cutaneous lesions (palms/soles)
          HSM
          Jaundice
          Anemia
          Snuffles
          Periostitis and metaphysial dystrophy
          Funisitis (umbilical cord vasculitis)



Late congenital:

          Frontal bossing
          Short maxilla
          High palatal arch
          Hutchinson teeth
          8th nerve deafness
          Saddle nose
          Perioral fissures
          Can be prevented with appropriate treatment

Hutchinson Teeth appear in late Congenital Syphilis

Diagnosing Syphilis ( not in newborns )

          Available serologic testing
          RPR/VDRL:  nontreponemal test
          Sensitive but NOT specific
          Quantitative, so can follow to determine disease activity and treatment response
          MHA-TP/FTA-ABS:  specific treponemal test
          Used for confirmatory testing
          Qualitative, once positive always positive
          RPR/VDRL screen in ALL pregnant women early in pregnancy and at time of birth
          This is easily treated!!

CDC Definition of Congenital Syphilis:

          Confirmed if T. pallidum identified in skin lesions, placenta, umbilical cord, or at autopsy
          Presumptive diagnosis if any of:
          Physical exam findings
          CSF findings (positive VDRL)
          Osteitis on long bone x-rays
          Funisitis (“barber shop pole” umbilical cord)
          RPR/VDRL >4 times maternal test
          Positive IgM antibody
          IgG can represent maternal antibody, not infant infection
          This is VERY intricate and often confusing
          Consult your RedBook (or peds ID folks) when faced with this situation

Treatment:

          Penicillin G is THE drug of choice for ALL syphilis infections
          Maternal treatment during pregnancy very effective (overall 98% success)
          Treat newborn if:
          They meet CDC diagnostic criteria
          Mom was treated <4wks before delivery
          Mom treated with non-PCN med
          Maternal titers do not show adequate response (less than 4-fold decline)

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