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Climbing congenital syphilis rates cause concern for pediatricians
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NEW YORK — The current rates of congenital syphilis are higher than in previous outbreaks, with the infection noted in 15.7 per 100,000 live births, according to a presentation at the 2017 Infectious Diseases in Children Symposium.
Joseph A. Bocchini, Jr., MD, professor and chairman of the department of pediatrics at Louisiana State University Health Sciences Center – Shreveport, called this “a significant outbreak of babies in utero with congenital syphilis.” This increase can be observed throughout the United States through the number of primary and secondary cases, particularly in the West (365.5%), Northeast (100%), South (29.9%) and Midwest (23.5%).
“Congenital syphilis is a completely preventable infection,” Bocchini said in his presentation. “We know that untreated early syphilis that has been acquired within the previous 4 years will commonly infect the fetus. Fetal infection [rates] in these circumstances may be as high as 80%, with fetal loss as high as 40%.”
Signs and symptoms of congenital syphilis vary, but may include stillbirth, hydrops fetalis and preterm birth; however, many infants are asymptomatic at birth. Bocchini said that within the first 8 weeks of life, an infant with congenital syphilis may exhibit a rash, desquamation, hepatosplenomegaly, snuffles, pneumonia, pseudoparalysis and osteochondritis.
A careful and comprehensive examination of the infant, in addition to comparison with maternal testing and other laboratory tests, should be completed to determine the appropriate treatment. According to Bocchini, those with proven or highly probable congenital syphilis may be treated with aqueous crystalline penicillin G or procaine penicillin G, or both, for a duration of 10 days.
Although treatment is possible in neonates, the transmission of infection in utero is avoidable. Pregnant women with syphilis can prevent the spread of disease with an appropriate penicillin treatment for at least 30 days before delivery. The efficacy of this method is between 86% and 98%. The efficacy of this treatment is heightened when it is administered within the first 20 weeks of pregnancy.
“The majority of mothers who gave birth to children with congenital syphilis either had no prenatal care or late prenatal care, had syphilis diagnosed at time of delivery, or they had syphilis diagnosed late in pregnancy and they were unable to complete the appropriate therapy by 30 days before delivery,” Bocchini said. “These [women] represent failures of our current system to treat pregnant women appropriately during pregnancy, to identify women who are infected and to treat them to prevent infection in their infants.”
According to Bocchini, virtually every state requires a test for syphilis to be performed on the first prenatal visit; however, some pregnant women require additional testing, including those with a history of previous infection, incarceration, illicit drug use or multiple and concurrent partners. These women should be screened at the beginning of the third trimester and at delivery using treponemal and nontreponemal tests. The infant can then be screened through placental or tissue testing.
“For you to manage a patient who is born to a mother who may have syphilis, you really need to try and find the maternal records. It is really important to determine if the mother was treated adequately and what her response to the treatment was,” Bocchini said. “It may take a few months for [test results] to fall, so you really need to see if the patient was treated and whether there was a significant fall or insignificant rise.” –by Katherine Bortz
Reference:
Bocchini JA. Syphilis: The great mimicker is back. Presented at: IDC NY. Nov. 18-19; New York.
Disclosure: Bocchini reports no relevant financial disclosures.