Congenital Syphillis

Question 1

What are the congenital infections that regularly affect babies?

Answer 1

TORCH
T-Toxoplasmosis 
O-others-syphillis, listeriosis, varicella, parvovirus B19
R- rubella 
C- cytomegalovirus 
H- herpes simplex virus

Question 2

What organisms causes congenital syphillis?

Answer 2

Treponema pallidum

Question 3

What are the early signs of congenital syphillis? <2 years

Answer 3

1. Hepatosplenomegaly and Jaundice
2. Maculopapular rash on the hands and feet
3. Rhinorhea
4. Skeletal abnormalities
5. Generalised lymphadenopathy (non-tender)
6. Pneumonia

Question 4

What are the late congenital syphillis signs?

>2 years

Answer 4

1. Hutchinsons triad
   - hutchinsons teeth
   - interstitial keratitis
   - sensorineural hearing loss
2. Saddle nose
3. Saber shins
4. Cranial nerve palsies
5. Frontal bossing of the skull
6. Mental retardation
7. Hydrocephalus

Question 5

How do we diagnose congenital syphillis?

Answer 5

We do an initial test of RPR and VDRL test

-an confirmatory test is the PCR of lesions or bodily fluids or dark field microscopy

Question 6

What is the treatment for congenital syphillis?

Answer 6

-IV penicillin G for both moms and babies

Question 7

What can we do to prevent it?

Answer 7

Screening moms is the best way

Question 8

How does the placenta look in congenital syphillis?

Answer 8

-it is pale, greasy and large

Question 9

What do the babies usually present with intra-uterine?

Answer 9

1. Intra-uterine growth growth restriction
2. Premature delivery
3. They usually die intra-iuterine

Question 10

What are the early skin clinical presentation?

Answer 10

1. Transient bulbous eruption involving the palms and the soles of the feet containing spirochetes
2. Condylomata lata (mucous patches in the angles of the mouth leading to fissuring and scarring in the angle of the mouth)
3. Desquamation
4. Maculopapular rash in the palms and feet
5. Petechiae

Question 11

What are the early haematological clinical signs?

Answer 11

1. Anaemia
2. Thrombocytopenia
3. Haemolytic anaemia
4. Leuko-erythroblastic
5. DIC

Question 12

What can we find on the bones in the early infection radiologically?

Answer 12

1. Wimbergers sign
2. Diaphysitis
3. Metaphyseal translucent band
4. Periosteal reaction

Question 13

What early CNS can we expect in congenital syphillis?

Answer 13

1. Convulsions
2. Hydrocephalus
   We would do LP’s routinely in these children’

Question 14

What early renal clinical signs can we expect in these babies?

Answer 14

-nephrotic syndrome

Question 15

What other clinical manifestations can we expect in these babies?

Answer 15

1. Pneumonia
2. Pseudo paralysis
3. Septicaemia
4. Pancreatitis

Question 16

What is the management of these babies?

Answer 16

1. Asymptotic baby- benzathine penicillin 50 000 IM in a single dose
2. Symptomatic baby without meningeal involvement -procaine penicillin G 300 000 IM for 10 days
3. Symptomatic baby with meningeal involvement-aqeous penicillin 50 000 in two divided doses per day

Question 17

When do we follow these babies?

Answer 17

• we have to follow up every 3 months and do a clinical exam and VDRL test each time
• if the baby continues to test positive then continue treatment for 12 months