Congenital syphilis: re-emergence in Trinidad - abstract

ABSTRACT

Twenty-three cases of congential syphilis (CS) were diagnosed shortly after birth at the Mount Hope Women's Hospital, Trinidad during the period Janaury 1985 to June 1988. Diagnostic criteria used were a positive VDRL test in the 19 liveborn infants (100 percent) and their mothers during pregnancy (20/30) or after delivery (3/23), and signs suggestive of CS, including osteochondritis and/or periostitis (58 percent), mucocutaneous changes (52 percent), hepatomegaly (83 percent), splenomegaly (70 percent), intrauterine growth retardation (39 percent), hydrops (13 percent), thrombocytopenia (11/16), jaundice (11/19), CSF pleocytosis (4/8), and increased CSF protein (5/8). In the 4 stillbirths and 3 of the 5 neonatal deaths, post mortem findings confirmed the diagnosis of CS. All 23 mothers attended antenatal clinic at least once; 16(70 percent), were 25 years or younger and there was significant reproductive wastage. Only 12 (60 percent) of the 20 gravidae, with a positive VDRL test received treatment. Of 11 untreated gravidae, 3 did not have a VDRL test done, 3 delivered before test results became known, 1 went into labour before going for treatment, and 4(2 of whom were substance abusers) did not comply with instructions to obtain treatment. The absolute number and the rate of CS per 100,000 births doubled from 1986-1987 in this series. A steep increase in the incidence of infectious syphilis is preventable and measures should be introduced (a) to detect syphilis early in all pregnant women, (b) to minimize delay in receiving VDRL test results, (c) to provide treatment and follow-up at the antenatal clinic, and (d) improve data capture and documentation of all forms of syphilis on a national scale (AU)