Congenital Syphilis - CPS Statement Flashcards
When should pregnant women be screened for syphilis?
First prenatal visit
If high risk:
Repeat at 28 - 32 weeks gestation
At delivery
What are the 2 types of syphilis testing?
RPR or VDRL - initial screen, used for titres to monitor treatment effectiveness
Treponemal test - includes TP-PA, FTA-ABS, also enzyme immunoassay (EIA), line-blot immunoassay (INNO-LIA). Will be positive for life after initial infection unless treated very early in disease course.
What is the expected RPR decline with adequate therapy for maternal primary syphilis?
Fourfold drop (e.g., from 1:32 dilutions to 1:8 dilutions) at six months, an eightfold drop at 12 months and a 16-fold drop at 24 months with primary syphilis
What is the expected RPR decline with adequate therapy for maternal secondary syphilis?
an eightfold drop at six months and a 16-fold drop at 12 months with secondary syphilis
What is the expected RPR decline with adequate therapy for maternal latent syphilis?
fourfold drop at 12 months with early latent syphilis
What are potential features of congenital syphilis present at birth? Hint: eight features
1) Necrotizing funisitis of umbilical cord
2) Rhinitis or sniffles
3) Rash (onset in 1st eight weeks)
4) Hepatomegaly/splenomegaly
5) Lymphadenopathy
6) Neurosyphilis
7) MSK involvement - bony changes
8) Hematologic changes
What are the potential MSK signs of congenital syphilis (which are present in infancy)?
Osteochondritis or perichondritis, seen initially radiographically (25% of cases) and later as pseudoparalysis, which can be confused with child abuse as there are both bony and of tissue limb changes.
What are the facial features that can develop in congenital syphilis?
Frontal bossing, poorly developed maxillas, saddle nose
What are “Clutton’s joints” in congenital syphilis?
Recurrent arthropathy and painless knee effusions
What dental anomalies can be present with congenital syphilis? (Hint: there are 2)
Hutchinson’s teeth: upper central and lateral incisors widely spaced and shaped like screwdrivers
Mulberry molars: first molars have dwarfing of the cusps and hypertrophy of the enamel surrounding the cusp, giving it the appearance of a berry
What hematologic anomalies can be present in congenital syphilis?
Anemia
Thrombocytopenia
What ocular issues can be a consequence of congenital syphilis?
Interstitial keratitis (occurring generally from age 2 - 20)
What cranial nerve can be affected as a consequence of congenital syphilis?
Eighth nerve deafness
(sensory neural deafness)
How would primary syphilis present in a mother?
Solitary, painless chancre
How would secondary syphilis present in a mother?
Secondary syphilis can have a wide variety of symptoms, especially fever, lymphadenopathy, rash, and genital or perineal condyloma latum
You have treated a baby for congenital syphilis - when do they require repeat RPR titres?
0, 3, 6 and 18 months of age
What is the treatment of choice for suspected congenital syphilis? (include dose and dosing interval)
10-day course of IV crystalline penicillin G of 50,000 units/kg given every 12 h to infants younger than one week of age, every 8 h to infants one to four weeks of age and every 6 h to infants older than four weeks of age
If an infant does NOT have congenital syphilis or did have congenital syphilis and was adequately treated, by which age should their TPPA revert to negative?
18 months
If initial CSF parameters were abnormal, when should the LP be repeated?
Obtain CSF every 6 months until normal
You have an infant whose mother was adequately treated for late latent syphilis. When should you do serologies for this infant?
0, 6 and 18 months
You have an infant whose mother was treated for primary, secondary or early latent syphilis during pregnancy more than four weeks before delivery, with adequate fall in her RPR titres and no evidence of relapse or reinfection. When do you repeat serologies for this infant? How often do you examine?
0, 3, 6 and 18 months
Baseline P/E, repeat assessment at 1, 2, and 3 months
You have an infant whom you are following with serial VDRL testing. At 6 months, the infant has a positive VDRL (and TT). What do you do?
Full workup and likely treatment
