Update on syphilis in pregnancy: marrying basic science advances and clinical perseverance to solve an ancient public health problem.

PURPOSE OF REVIEW: While the clinical disease of syphilis, its consequences in pregnancy, and its sensitivity to penicillin treatment have remained relatively unchanged for a century or more, new technologies and basic discoveries in syphilis research have translated into tangible advances in clinical diagnosis, treatment, and prevention. The purpose of this review is to help the reader understand some of the recent relevant scientific publications on syphilis and its causative organism in a clinical obstetric context. RECENT FINDINGS: Rates of adult and congenital syphilis have risen dramatically in the last decade despite public health efforts. Penicillin shortages and lack of screening or adequate treatment have all contributed to global disease burden. Advances in genomic and microbiological characterization of this spirochete have led to new developments in serologic and molecular diagnosis as well as evaluation of potential vaccine candidates. Until a syphilis vaccine is available, substance use disorders and lack of screening in pregnancy are associated with increased congenital syphilis, and these challenges will require novel solutions to fully address this public health crisis. SUMMARY: Addressing the burden of congenital syphilis demands that obstetricians stay well informed of new tools and resources for diagnosis, treatment, and prevention of syphilis now and in the future.

Congenital syphilis: the re-emergence of a forgotten disease.

A preterm newborn presented at birth with generalised oedema, disseminated bullous and desquamative exanthema with palmoplantar involvement and hepatomegaly, admitted to the neonatal intensive care unit with severe multisystemic disease, haemodynamic instability and respiratory distress. The mother had a history of treated latent syphilis before pregnancy. Venereal Disease Research Laboratory screening was negative in the first trimester, titre 1:2 in second trimester and 1:32 in the third trimester, a result only available to the medical team at birth. The mother's rapid plasma reagin (RPR) titre was 1:64 at birth. The newbon's RPR titre was 1:256, confirming the diagnosis of early congenital syphilis. The newborn was treated with aqueous penicillin G, with clinical and laboratorial progressive recovery. Congenital syphilis is a preventable disease, but despite prenatal screening programmes, it remains a significant public health issue worldwide with high morbidity and mortality.

Pemphigus syphiliticus with Jarisch-Herxheimer reaction in a newborn.

Congenital syphilis is a serious, disabling, and life-threatening infection that is transmitted transplacentally from mother to fetus. Early diagnosis is often difficult because affected infants are usually asymptomatic at birth and clinical findings are often subtle and nonspecific. Pemphigus syphiliticus is an early presentation of congenital syphilis which is characterized by fluid-filled vesicles and bullae which appear mostly on the extremities and tend to rapidly desquamate and erode. Awareness of the clinicians to this early cutaneous manifestation and possible treatment reaction will allow for prompt diagnosis and adequate treatment of syphilis-infected patients.

[Syphilis in Argentina]. / Sífilis en Argentina.

Syphilis is a disease preventable through sexual protection barriers, and curable with a simple treatment. Despite this, between 2010 and 2019, its incidence almost tripled in Argentina, reaching 56.1/100 000. The most affected are young people (15-24 years old), with a higher percentage of women, especially among pregnant women, in whom it increased from 2.3% to 5.8%, with a peak of 7.7% between 15 and 24 years old. Cases of secondary or tertiary syphilis, detected by control tests, are on the rise. The increase in syphilis is linked to HIV. For this reason, rapid detection tests must be carried out jointly at the first level of care, which facilitates access to the diagnosis and treatment of positive cases, with the corresponding guidance and control. Treatment with penicillin, for which no resistance has been found, is the key component of control. Doxycillin is also used (not in pregnant women), or ceftriaxone. The resistance of Treponema pallidum to azithromycin is increasing, so its use should be avoided. In 2022, 696 cases of congenital syphilis were reported. The national rate is 1.3 per 1000 live births. The majority of reported cases come from the public sector. Maternal syphilis is, in low-income areas, the most common cause of stillbirths. Strict application of existing regulations, strengthening the primary care system, and prevention during pregnancy can contribute to controlling and eliminating the syphilis problem in Argentina.

La sífilis es una enfermedad prevenible mediante barreras de protección sexual, y curable por un sencillo tratamiento. A pesar de esto, entre 2010 y 2019, su incidencia casi se triplicó en Argentina, alcanzando 56.1/100 000. Los más afectados son los jóvenes (15-24 años), con mayor porcentaje de mujeres, especialmente entre las embarazadas, en que aumentó de 2.3% a 5.8%, con un pico de 7.7% entre 15 y 24 años. Los casos de sífilis secundaria o terciaria, detectados por pruebas de control, están en aumento. El aumento de sífilis va unido al HIV. Por ello las pruebas rápidas de detección deben hacerse conjuntamente en el primer nivel de atención, lo que facilita el acceso al diagnóstico y al tratamiento de los casos positivos, con la orientación y control correspondientes. El tratamiento con penicilina, para la que no se ha hallado resistencia, es el componente clave del control. También se usa doxicilina (no en embarazadas), o ceftriaxona. Está aumentando la resistencia del Treponema pallidum a la azitromicina, por lo que debe evitarse su empleo. En 2022 se notificaron 696 casos de sífilis congénita. La tasa de nacional es 1.3 por 1000 nacidos vivos. La mayoría de los casos notificados provienen del sector público. La sífilis materna es, en áreas de bajos recursos, la causa más común de nacidos muertos. La aplicación estricta de las normas existentes, el fortalecimiento del sistema de atención primaria, y la prevención durante el embarazo, pueden contribuir a controlar y eliminar el problema de la sífilis en Argentina.

[Association between different treatment timings and adverse neonatal outcomes in pregnant women with syphilis during pregnancy].

Objective: To analyze the association between different treatment timings and adverse neonatal outcomes (premature birth, death, congenital syphilis) in syphilis-infected pregnant women. Methods: The National Management Information System for Prevention of HIV, Syphilis and HBV Mother-to-Child Transmission was used to collect information on the detection and treatment of syphilis-infected pregnant women and their newborns in Guangdong Province from October 2011 to December 2021. According to the gestational weeks of syphilis-infected pregnant women receiving penicillin treatment for the first time, they were divided into four groups: treatment in the first trimester, treatment in the second trimester, treatment in the third trimester, and no treatment during pregnancy. Multivariate logistic regression was used to analyze the association between different treatment timings and adverse neonatal outcomes in syphilis-infected pregnant women. Results: A total of 22 483 syphilis-infected pregnant women were included. The number of pregnant women who started treatment in the first trimester, second trimester, and third trimester and did not receive treatment during pregnancy were 4 549 (20.23%), 8 719 (38.78%), 2 235 (9.94%) and 6 980 (31.05%), respectively. Compared with pregnant women who started treatment in the first trimester, pregnant women who did not receive anti-syphilis treatment during pregnancy had increased risks of neonatal preterm birth (OR=1.42, 95%CI: 1.24-1.62), death (OR=4.27, 95%CI: 1.64-14.69) and congenital syphilis (OR=12.26, 95%CI: 6.35-27.45). At the same time, the risk of congenital syphilis in the newborns of pregnant women who started anti-syphilis treatment in the second trimester (OR=2.68, 95%CI: 1.34-6.16) and third trimester (OR=6.27, 95%CI: 2.99-14.80) also increased. Conclusion: Early initiation of anti-syphilis treatment during pregnancy in patients with syphilis can improve neonatal outcomes.

Tratamento da sífilis congênita e sua repercussão na rotina neonatal / Treatment of congenital syphilis and its impact on the neonatal routine

Introdução: A sífilis é uma doença infecto-contagiosa transmitida pela via sexual (sífilis adquirida) e verticalmente (sífilis congênita) durante a gestação pela placenta da mãe para o feto. Objetivos: Apresentar o tratamento proposto pelo Ministério da Saúde através do protocolo clínico atual para Sífilis transmitida verticalmente e relatar se foi uma opção viável, já que não havia a disponibilidade da Benzilpenicilina Procaína em todos os estados brasileiros; analisar quantas internações por um período mínimo de 10 dias poderiam ter sido evitadas se houvesse a disponibilidade da Benzilpenicilina Procaína conforme está no protocolo do Ministério da Saúde sendo notada a falta de tal medicação, prioritariamente, no Estado de São Paulo. Método: Estudo retrospectivo, investigativo, com revisão de prontuários de 23 gestantes com Sífilis e os respectivos recém-nascidos durante todo o ano de 2020, na maternidade de um hospital escola em Catanduva-SP. Resultados: Todos os recém-nascidos de mães com Sífilis na gestação recebiam o tratamento e/ou o seguimento para Sífilis Congênita de acordo com o teste - VDRL colhido ao nascimento. O tratamento para Sífilis Congênita sem Neurossífilis foi realizado com Benzilpenicilina Cristalina durante 10 dias, por via endovenosa, em quatorze bebês (56,5%). Destas 14 internações, apenas um caso de Sífilis Congênita com Neurossífilis realmente necessitava permanecer internada para tratamento endovenoso com Benzilpenicilina Cristalina. Uma mãe evadiu-se do hospital com o recém-nascido e não completou o tratamento no hospital-escola deste estudo, e para oito (34,8%) bebês definiu-se apenas o seguimento ambulatorial como conduta de acordo com as diretrizes do Ministério da Saúde. Em relação às intercorrências acometidas aos bebês que ficaram internados foram basicamente a dificuldade de amamentação e a perda do acesso venoso periférico com recorrência. Conclusão: A discordância nas Diretrizes do Ministério da Saúde para o tratamento da Sífilis Congênita, mesmo as mais atualizadas (2020), ocorre em decorrência da indisponibilidade desta medicação de baixo custo, Benzilpenicilina Procaína, aplicada intramuscular, o que facilita sua administração a nível de Unidades Básicas de Saúde e dispensa a internação hospitalar de bebês com necessidade de tratamento para a Sífilis Congênita sem Neurossífilis. Com isso, o trabalho sugere que a disponibilização da Benzilpenicilina Procaína para o tratamento dos casos simples de Sífilis Congênita culminará em incontáveis benefícios para o binômio mãe-bebê

Introduction: Syphilis is an infectious contagious disease transmitted sexually (acquired syphilis) and vertically (congenital syphilis) during pregnancy through the placenta from the mother to the fetus. Objectives: To prove whether the treatment proposed by the Ministry of Health through the current clinical protocol for vertically transmitted syphilis is a viable option, since Benzylpenicillin Procaine is not available in all Brazilian states; and to analyze how many hospitalizations for a minimum period of 10 days could have been avoided if Benzylpenicillin Procaine had been available as per the Ministry of Health protocol, with the lack of such medication being noted, primarily, in the State of São Paulo. Method: Retrospective, investigative study, reviewing the medical records of 23 pregnant women with Syphilis and their newborns throughout the year 2020, in the maternity hospital of a teaching hospital in Catanduva-SP. Results: All newborns of mothers with Syphilis during pregnancy received treatment and/or follow-up for Congenital Syphilis according to the test - VDRL collected at birth. Treatment for Congenital Syphilis without Neurosyphilis was performed with crystalline Benzylpenicillin for 10 days, intravenously, in fourteen babies (56.5%). Of these 14 hospitalizations, only one case of Congenital Syphilis with Neurosyphilis really needed to remain hospitalized for intravenous treatment with Crystalline Benzylpenicillin. One mother escaped from the hospital with the newborn and did not complete the treatment at the Hospital-Escola, and eight (34.8%) babies were defined only as outpatient follow-up as conduct in accordance with the guidelines of the Ministry of Health. Regarding the complications affected by the babies who were hospitalized, they were basically the difficulty in breastfeeding and the loss of peripheral venous access with recurrence. Conclusion: Disagreement in the Guidelines of the Ministry of Health for the treatment of Congenital Syphilis, even the most up-to-date ones (2020) occurs due to the unavailability of this low-cost medication, Benzylpenicillin Procaine, applied intramuscularly, which facilitates its administration at the Unit level Health Basics and waives the hospitalization of babies in need of treatment for Congenital Syphilis without Neurosyphilis. With this, the work suggests that the availability of Procaine Benzylpenicillin for the treatment of simple cases of Congenital Syphilis will culminate in countless benefits for the mother baby binomial

Introducción: La sífilis es una enfermedad infectocontagiosa de transmisión sexual (sífilis adquirida) y vertical (sífilis congénita) durante el embarazo a través de la placenta de la madre al feto. Objetivos: Probar si el tratamiento propuesto por el Ministerio de Salud a través del protocolo clínico vigente para la sífilis de transmisión vertical es una opción viable, ya que la Bencililpenicilina Procaína no está disponible en todos los estados brasileños; y analizar cuántas hospitalizaciones por un período mínimo de 10 días se podrían haber evitado si la bencililpenicilina procaína hubiera estado disponible según el protocolo del Ministerio de Salud, observándose la falta de dicha medicación, principalmente, en el estado de São Paulo. Método: Estudio retrospectivo, investigativo, revisando las historias clínicas de 23 gestantes con Sífilis y sus recién nacidos a lo largo del año 2020, en la maternidad de un hospital universitario de Catanduva-SP. Resultados: Todos los recién nacidos de madres con Sífilis durante el embarazo recibieron tratamiento y/o seguimiento para Sífilis Congénita según prueba - VDRL recogido al nacer. El tratamiento de la Sífilis Congénita sin Neurosífilis se realizó con Bencilpenicilina cristalina durante 10 días, por vía intravenosa, en catorce bebés (56,5%). De estas 14 hospitalizaciones, solo un caso de Sífilis Congénita con Neurosífilis necesitó realmente permanecer hospitalizado para recibir tratamiento intravenoso con Bencilpenicilina Cristalina. Una madre se escapó del hospital con el recién nacido y no completó el tratamiento en el hospital escuela en este estudio, y ocho (34,8%) bebés fueron definidos solo como seguimiento ambulatorio como conducta de acuerdo con las directrices del Ministerio de Salud. En cuanto a las complicaciones que afectaron a los bebés que fueron hospitalizados fueron básicamente la dificultad en la lactancia y la pérdida del acceso venoso periférico con recurrencia. Conclusión: La inconformidad en las Directrices del Ministerio de Salud para el tratamiento de la Sífilis Congénita, incluso las más actualizadas (2020) se da por la indisponibilidad de este medicamento de bajo costo, la Bencilpenicilina Procaína, de aplicación intramuscular, que facilita su administración a nivel de Unidad Básicos de Salud y renuncia a la hospitalización de bebés con necesidad de tratamiento por Sífilis Congénita sin Neurosífilis. Con ello, el trabajo sugiere que la disponibilidad de la Bencilpenicilina Procaína para el tratamiento de casos simples de Sífilis Congénita culminará en innumerables beneficios para el binomio madre-bebé

Case Series of Stillbirths Due to Syphilis in Edmonton, Alberta, Canada.

BACKGROUND: Data on the incidence and characteristics of stillbirths attributed to congenital syphilis were collected. METHODS: We extracted data on stillbirths in the Edmonton Zone on January 1, 2015, through June 30, 2021, born to persons diagnosed with infectious syphilis (primary, secondary, early latent, or early neurosyphilis) during pregnancy or at the time of delivery. RESULTS: Of 314 infants documented to be exposed to infectious syphilis during gestation, 16 (5.1%) were stillborn. Three of the 16 females with stillbirths were diagnosed with syphilis during pregnancy but not treated, 12 were diagnosed only at the time of stillbirth (1 of whom was treated early in pregnancy and presumably reinfected), and 1 had a stillbirth in the week after one dose of benzathine penicillin G. CONCLUSIONS: Stillbirths due to congenital syphilis were all due to failure to treat syphilis in pregnancy. Innovative strategies to prevent syphilis in the community and to reach those experiencing barriers to care are urgently required to not miss opportunities to diagnose and treat syphilis as early as possible during pregnancy.

Congenital Syphilis Infection: A Case Study.

Congenital syphilis (CS) infection occurs by way of vertical transmission of the bacteria Treponema pallidum from mother to fetus. While nearly eliminated by the turn of the twenty-first century, CS has resurged in recent years and currently represents a worldwide public health calamity secondary to insufficient prenatal care and inadequate maternal treatment. Fetal and neonatal consequences include stillbirth, cutaneous and visceral symptoms, asymptomatic infection, and death. Given the rise in cases in both wealthy and resource-poor areas, neonatal clinicians are obligated to maintain acumen specific to risk factors, manifestations, and treatment regimens. However, limited data guide postnatal treatment regimens, particularly in preterm neonates. We present a case report of a preterm female with CS and integrated review of the literature. Our findings indicate that CS is preventable through efficient and judicious perinatal screening, early detection, and adequate treatment of maternal syphilis during pregnancy.

Congenital syphilis: a rare presentation of a forgotten infection.

Congenital syphilis (CS), a common but forgotten disease has a broad spectrum of clinical presentation. Vertical transmission of this spirochaetal infection from the pregnant mother to the foetus can result in varied manifestations ranging from asymptomatic infection to life- threatening conditions in the form of stillbirth and neonatal death. The haematological and visceral manifestations of this disease can closely mimic various conditions including haemolytic anaemia and malignancies. Congenital syphilis should be considered as a differential in any infant presenting with hepatosplenomegaly and haematological abnormalities even if the antenatal screen was negative. We report a 6-month-old infant with congenital syphilis presenting with organomegaly, bicytopenia and monocytosis. A strong index of suspicion and early diagnosis is the key to the good outcome as treatment is simple and cost- effective.

Evaluation of the follow-up of children treated for congenital syphilis in a municipality in the state of Espírito Santo, when it lacked crystalline penicillin / valiação do acompanhamento de crianças tratadas para sífilis congênita em município do estado do espírito santo em época de falta de penicilina cristalina

Introduction: Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. In Brazil, its incidence has increased, along with the lack of penicillin, the antibiotic of choice for congenital syphilis, from 2014 to 2017. During this period, children were treated with alternative drugs, but to date, data from the scientific literature do not recommend another antibiotic. Objective: To compare the progression, according to the established treatment, and evaluate the follow-up in health care facilities in Vila Velha (Espírito Santo) of children with congenital syphilis aged up to two years, born in Hospital Infantil e Maternidade Alzir Bernardino Alves ­ a reference in neonatology and low-risk pregnancy in the state at the time ­ from 2015 to 2016, when the hospital experienced a greater lack of penicillin. Methods: This is a retrospective cross-sectional observational study based on data from medical records of the hospital and other healthcare facilities in the city. We performed statistical analyses, per health district, of epidemiological and sociodemographic data, as well as those related to visits, their frequency, and clinical profile, according to the follow-up parameters proposed by the Ministry of Health at the time. Results: Medical records of 121 children were evaluated, presenting as the main findings: only 35% of the children completed the follow-up; among those treated with ceftriaxone, 55.2% completed the follow-up, and 100% of the children whose venereal disease research laboratory was greater than that of their mother at birth completed the follow-up. Of the symptomatic children at birth who remained or became symptomatic at follow-up, 58.8% used ceftriaxone. Conclusion: Among symptomatic children at birth, most of those treated with ceftriaxone remained symptomatic at follow-up. The Counseling and Testing Center was the most successful facility in the follow-up of these children. District 5 had the lowest success rate in the follow-up of these patients, and districts 1 and 2 showed the lowest rates of appropriate approach to congenital syphilis during follow-up. (AU)

Introdução: A sífilis é uma infecção sexualmente transmissível causada pela bactéria Treponema pallidum. No Brasil, sua incidência vem aumentando, acompanhada da falta de penicilina, antibiótico de escolha para a sífilis congênita, no período de 2014­2017. Nesse período, as crianças foram tratadas com medicamentos alternativos, porém dados da literatura científica até o momento não recomendam outro antibiótico. Objetivo: Comparar a evolução, de acordo com o tratamento instituído, e avaliar o acompanhamento nas unidades de saúde em Vila Velha (ES), até os dois anos de idade, das crianças com sífilis congênita nascidas no Hospital Infantil e Maternidade Alzir Bernardino Alves ­ referência em neonatologia e gravidez de baixo risco no estado na época ­ de 2015 a 2016, período em que houve maior falta de penicilina no hospital. Métodos: Estudo observacional do tipo transversal, retrospectivo, baseado em dados dos prontuários do hospital e outras Unidades de Saúde do município. Foram analisados estatisticamente, por região de saúde, dados epidemiológicos, sociodemográficos, bem como relativos às consultas, sua periodicidade e ao perfil clínico, de acordo com os parâmetros de seguimento propostos pelo Ministério da Saúde na época. Resultados: Avaliaram-se os prontuários de 121 crianças, obtendo-se como principais achados: somente 35% das crianças tiveram seguimento completo; das crianças tratadas com ceftriaxona, 55,2% tiveram seguimento completo, e 100% das crianças que tiveram VDRL maior que o da mãe no parto completaram o seguimento. Das crianças sintomáticas ao nascimento e que permaneceram ou ficaram sintomáticas no seguimento, 58,8% fizeram uso de ceftriaxona. Conclusão: Das crianças sintomáticas ao nascimento, as tratadas com ceftriaxona, em sua maioria, mantiveram-se sintomáticas no seguimento. O Centro de Testagem e Aconselhamento teve maior êxito no acompanhamento dessas crianças. A região 5 teve a menor taxa de êxito no seguimento desses pacientes, e as regiões 1 e 2 menor taxa de abordagem correta para sífilis congênita durante o seguimento. (AU)

Mucocutaneous manifestations of congenital syphilis in the neonate: A review of a surging disease.

Syphilis is an infection caused by Treponema pallidum. It is most commonly acquired through sexual transmission, although it can also be transmitted vertically across the placenta, resulting in congenital syphilis. Even with improved public health measures, testing, and treatment capabilities, primary, secondary, and congenital syphilis have all surged since 2012. Given this marked increase in both incidence and prevalence, here we present a comprehensive review of the clinical presentation, treatment, and management of congenital syphilis, with particular consideration given to the mucocutaneous manifestations of the disease in neonates.

Congenital syphilis as the cause of multiple bone fractures in a young infant case report.

BACKGROUND: The differential diagnosis of multiple unexplained bone fractures in a young infant usually includes child abuse or bone disease such as osteogenesis imperfecta. Bone abnormalities can occur in 60-80% of cases with congenital syphilis and may be the sole manifestation. However, this frequent manifestation of this rare disease such as congenital syphilis is frequently disregarded. We describe a case of a young infant with multiple long bone fractures diagnosed with congenital syphilis. CASE PRESENTATION: This 2-month-old male patient was referred to our hospital because of fractures of the ulna and distal radius bilaterally and noisy breathing with the suspicion of osteogenesis imperfecta. After thorough examination, the infant had anemia and a palpable spleen. We performed a screen for congenital infections among other investigations, which revealed positive non-treponemal and treponemal antibodies for syphilis. Hence the diagnosis for Congenital Syphilis was made. We performed a lumbar puncture (LP) which showed mild pleocytosis. The patient was treated with intravenous aqueous penicillin G 200 000 UI/KG per day for 10 days. In addition, a single dose of intramuscular penicillin G benzathine 50 000 UI/KG was given due to the abnormal result of CSF. On follow up admission 6 months later, the new syphilis serology had much improved and the new LP revealed no abnormal findings. CONCLUSIONS: We present this case report in order to remind of a common manifestation of congenital syphilis, a rare disease which needs to be included in the differential diagnosis of multiple unexplained fractures in early infancy. In our case the fractures were symmetric and bilateral and they were accompanied by anemia and mild hepatosplenomegaly which led to the investigation of congenital syphilis as a possible cause. However, two thirds of infants with congenital syphilis are asymptomatic at birth. All women should have a proper syphilis screening during pregnancy.

Congenital neurosyphilis presenting as neonatal sepsis.

INTRODUCTION: Congenital syphilis involves any organs with various symptoms, including neurological signs. Neurosyphilis is a severe syphilis complication that can develop at any stage of illness. CASE PRESENTATION: A 2,520 g male infant was spontaneously born at term from an untreated syphilis mother. Physical examination revealed decreased consciousness, respiratory distress, seizure, but without neurologic abnormality sign. The serum and cerebrospinal fluid Venereal Disease Research Laboratory and Treponemal Pallidum Hemagglutination Assay TPHA tests titters were 1:16 and 1:1,280, respectively. The diagnosis at admission was respiratory failure and neonatal sepsis. The infant was mechanically ventilated and treated with early management of sepsis. Blood culture was sterile later on. Then, the infant was administered intramuscular benzathine penicillin G (50,000 units/kg/dose) for a total of three weeks. The infant's condition was improved during the treatment. CONCLUSIONS: There are many challenges associated with screening and monitoring neurosyphilis in congenital syphilis. Congenital syphilis presenting as sepsis is easily misdiagnosed as bacterial sepsis.

Congenital syphilis prevention in the context of methamphetamine use and homelessness.

BACKGROUND AND OBJECTIVES: Congenital syphilis (CS) is increasing in the United States and is associated with intersecting social and structural determinants of health. This study aimed to delineate birthing parent characteristics associated with CS in an adjusted model. METHODS (N = 720): People diagnosed with syphilis during pregnancy from 2017 to 2018 who were interviewed and linked to infants in the California state surveillance system were included (herein, "birthing parents"). Sociodemographic and clinical CS risk factors informed a stepwise multivariable logistic regression model in which the outcome of interest was infants born with CS. CS prevention continuums delineated the proportion of pregnant people with syphilis who completed steps (e.g., prenatal care entry, syphilis testing, treatment) needed to prevent CS; the outcome was delivering an infant without CS. We stratified continuums by homelessness and methamphetamine use to explore differences in CS outcomes. RESULTS: Of 720 birthing parents, 245 (34%) delivered an infant with CS. Although CS was initially associated with homelessness (odds ratio [OR] = 2.5, 95% confidence interval [CI]: 1.6, 4.0) and methamphetamine use (OR = 2.1, 95% CI: 1.4, 3.1), the addition of prenatal care into a final adjusted model attenuated these associations to not significant. In CS prevention continuums, delivering an infant without CS was less likely for people who reported methamphetamine use (p < .001) and/or homelessness (p < .001). However, when examining only those who received prenatal care, statistical differences for these predictors no longer existed. In the final adjusted model the following were associated with CS: no prenatal care (OR = 16.7, 95% CI: 9.2, 30.3) or late prenatal care (OR = 2.9, 95% CI: 1.9, 4.2); early stage of syphilis (OR = 2.6, 95% CI: 1.8, 3.7); living in Central California (OR = 2.1, 95% CI: 1.1, 4.2). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: This is the first analysis to explore birthing parent characteristics associated with delivering an infant with CS in an adjusted model. We demonstrate that prenatal care, when accessed, can result in effective CS prevention among people who are unhoused and/or using methamphetamine equally well compared to counterparts without these risk factors.

Factors associated with congenital syphilis: A retrospective study in Jiangxi Province, China.

BACKGROUND: There are a lack of studies about factors influencing congenital syphilis (CS) in economically underdeveloped areas, such as Jiangxi Province, China. METHODS: A retrospective study was conducted based on the information system of prevention of mother-to-child transmission of syphilis management in Jiangxi Province, China. Pregnant women with syphilis infection who delivered ≥28 gestational weeks and registered in this system from 1 January 2013 to 2030 June 2018 were enrolled. Maternal characteristics and treatment regimens associated with CS were evaluated using multivariable regression analysis. RESULTS: 1196 syphilis infected mothers and their 1207 infants were included in the analyses, and 116 infants were diagnosed with CS, providing an overall incidence of 9.61% (116/1207). Multivariable logistic regression analysis showed that increasing maternal age was barely associated with the risk of CS (adjusted odds ratio (aOR) = 0.97, 95% CI, 0.93-1.00, p = .047). Women with a high nontreponemal serum test titer (≥1:8) had a 126% increased risk of delivering an infant with CS than those with a low titer (<1:8) (aOR = 2.26, 95% CI, 1.51-3.39, p < .001). The risk for CS decreased significantly in infants born to mothers receiving adequate treatment than those receiving no treatment (aOR = 0.36, 95% CI, 0.21-0.61, p < .001). CONCLUSIONS: Adequate treatment is critical for the prevention of CS. Further strategies focusing on early diagnosis and adequate treatment among syphilis infected pregnant women, particularly among those with younger age and high nontreponemal titer, should be strengthened to prevent CS.

Addressing the crisis of congenital syphilis: Key findings from an evaluation of the management of syphilis in pregnancy and the newborn in South-East Queensland.

BACKGROUND: Syphilis in pregnancy and congenital syphilis (CS) are increasing in Australia. Prevention of adverse outcomes requires adherence to management guidelines. AIMS: The aim is to evaluate the management of syphilis in pregnant women and their newborns. MATERIALS AND METHODS: A retrospective study of public health notifications, clinical records and testing results of women with positive syphilis serology in pregnancy requiring treatment from 2016 to 2018 inclusive across South-East Queensland was conducted. Management was described and compared with contemporary guidelines from the Australasian Society of Infectious Diseases, the Communicable Diseases Network Australia and the United States Centers for Disease Control and Prevention. RESULTS: Of 30 women identified, 22 (73%) had management consistent with the guidelines (stage-appropriate penicillin regimen, appropriate dosing interval and treatment completed greater than 30 days before delivery). Only 14 (47%) women had documentation of partner testing and/or treatment. Of 26 mother-infant pairs with complete data, 16 (62%) had investigations at delivery consistent with recommendations (parallel maternal-infant rapid plasma reagin, infant syphilis immunoglobulin M, placental histopathology +/- syphilis polymerase chain reaction and infant clinical examination). One infant met the criteria for confirmed CS. Five infants received penicillin therapy. Only seven (27%) infants had serological monitoring after discharge. CONCLUSIONS: Management can be optimised with timely maternal testing and treatment, comprehensive partner screening and treatment, strict adherence to seven-day penicillin dosing for late latent syphilis and thorough maternal and infant testing after treatment and delivery. If maternal treatment was inadequate in pregnancy, consideration needs to be given to close evaluation and empiric treatment of the infant.

Severe Congenital Syphilis in the Neonatal Intensive Care Unit: A Retrospective Case Series.

BACKGROUND: There has been a 291% relative increase in congenital syphilis (CS) cases in the United States from 2015 to 2019. Although the majority of affected fetuses/infants are stillborn or are asymptomatic, a subset is born with severe clinical illness. We describe a series of severe CS cases in the neonatal intensive care unit. METHODS: Retrospective review of infants with CS, admitted to the Duke Intensive Care Nursery from June 2016 to February 2020. We recorded birthweight, gestational age, medications, procedures, diagnoses, laboratory data and outcomes. Severe symptoms included: birth depression, hypoxic ischemic encephalopathy (HIE), disseminated intravascular coagulopathy and/or persistent pulmonary hypertension (PPHN). RESULTS: Seven infants with CS were identified and 5 with severe presentations were included. Median gestational age was 35.1 weeks (range: 29-37 weeks, median: 35 weeks). All infants required intubation at birth, 2 required chest compressions and epinephrine in the delivery room. One had hydrops fetalis and died in the delivery room. All 4 surviving infants had HIE, severe PPHN, hepatitis and seizures. All infants had a positive rapid plasma reagin, and were treated with penicillin G. Maternal rapid plasma reagin was pending for 3 of 5 infants at delivery, and later returned positive; 2 were positive during pregnancy but not treated. Other infectious work-up was negative. Three infants survived to discharge. CONCLUSION: CS can be associated with HIE, PPHN and disseminated intravascular coagulopathy in affected infants. Clinicians should have a high index of suspicion and include CS in their differential diagnoses. This study also highlights the importance of adequate treatment of identified cases and screening during the third trimester and at delivery.

Diagnosis, treatment, and notification of syphilis during pregnancy in the state of Goiás, Brazil, between 2007 and 2017.

OBJECTIVE: To analyze the evolution of syphilis during pregnancy notification regarding clinical classification, diagnosis and treatment in the state of Goiás, Brazil, between 2007 and 2017. METHODS: This is a time-series study, analyzing data provided by the Health Secretariat of the state of Goiás. The variables related to the diagnosis and treatment of pregnant women and their partners were analyzed, and their evolution trend during the years. Descriptive statistics and percentage calculation were used. Cochran-Armitage test with a significance level α = 0.05 was used to determine increase and decrease trends. RESULTS: During the period, 7,774 cases were notified. The highest percentage of notifications occurred in the second trimester of pregnancy (39.8%) and corresponded to primary syphilis (34.1%). The most frequent treatment prescribed was benzathine benzylpenicillin with a dosage of 7.2 million (43.8%). Between 2007 and 2017, there was an increasing trend in the notification percentage of latent (14.1% to 30.7%), secondary (5.2% to 19%), and tertiary syphilis (4.4% to 11.4%). The treatment with benzathine benzylpenicillin with a dosage of 7.2 million also increased (19.3% to 59.6%). The percentages of primary syphilis decreased (43.4% to 22.1%), as well as other treatments' percentages. CONCLUSIONS: Latent syphilis notification of pregnant women and treatment with penicillin at the dosage of 7,200,000 IU increased. Notification forms' data completeness also increased for the variables clinical classification and treatment, suggesting improvements in the notification process.

[Syphilis, the forgotten disease]. / Syfilis ­ glömd men inte borta.

The incidence of syphilis was decreasing during the last decades of the 20th century, partly due to the awareness and fear of hiv. However, an increase is now apparent in many countries. It is still uncommon in Sweden compared to chlamydia and gonorrhoea, and the incidence is 4.6/100.000 inhabitants. The infection can be latent and without symptoms, but also manifest itself as a painless genital ulcer, with rash and fever, or as neurosyphilis. Congenital infection due to transmission of the syphilis spirochete from an infected mother to her fetus is still a problem in many parts of the world. In order to prevent congenital syphilis it is important for all pregnant women to have access to maternal care during their pregnancy, and to get efficient treatment if diagnosed with syphilis.

An analysis of the clinical features of children with early congenital Syphilis and Syphilitic Hepatitis.

BACKGROUND: The infection rate of congenital syphilis is gradually increasing, the clinical manifestations of some children with congenital syphilis are abnormal liver function, which is given the clinical diagnosis of syphilitic hepatitis. At present, there are few studies on the clinical features of children with early congenital syphilis combined with syphilitic hepatitis, so we set out to do such a study. We compared the liver function indicators before and after the treatment of syphilis to find the clinical features that can provide guidance for clinical diagnosis and treatment. METHODS: This study collected clinical data on 51 children with early congenital syphilis combined with syphilitic hepatitis in Beijing Ditan Hospital, affiliated with Capital Medical University, between April 2014 and October 2019. We observed their age, gender, clinical symptoms, and physical symptoms, as well as the pregnancy and childbirth history of their mothers. We also compared the liver function indicators before and after the treatment of the syphilis and analyzed the children's clinical features. RESULTS: The results of this study showed that the clinical manifestations in children with early congenital syphilis combined with syphilitic hepatitis were diverse. The most common clinical manifestation was anemia (56.9 %), followed by syphilitic rash (54.9 %), hands, feet, and whole-body peeling (35.3 %), and splenomegaly (29.4 %). Liver damage caused by a syphilis infection tends to result in elevated alanine aminotransferase, aspartate aminotransferase, and bilirubin, while albumin decreases. After the syphilis treatment, the liver function indexes were significantly improved compared with before treatment, and the difference was statistically significant (all p < 0.05). CONCLUSIONS: A child with abnormal liver function, especially with anemia, skin rash, peeling, abdominal distension, and hepatosplenomegaly should be highly suspected of having a syphilis infection. Once the diagnosis is made, the appropriate standard penicillin treatment should be started as soon as possible to improve the condition and prognosis of the child.