Syphilis in pregnancy Flashcards

1
Q

Incidence in Australia

A

18.3/100 000 people

women: 15.9/100 000 in 15-19 year
15.1/100 000 in 20-24 year
13.7 /100 000 in 25 to 29 years

Incidence is 40x higher in indigenous and TSI women
Higher incidence in remot areas

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2
Q

Congenital Infection

A

Occurs transplacentally and can be transmitted even in latent or tertiary stage

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3
Q

Clinical relevance

A

Early untreated syphilis will result in congenital infection in 70-100% of neonates
Still birth 30%

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4
Q

Early Neonatal signs

A

Hydrocephalus
Characteristic skin lesions
Lymphadenopathy
HSM
FTT
Meningitis
Seizures
Mental impairment
Osteochondritis
Pseudoparalysis
- Some signs may only be seen closer to age 2 years
Later signs of congenital syphilis
o Late congenital syphilis (after 2 years)
§ Blunted upper incisors
§ Gummatous ulcers
§ Frontal bossing
§ Short maxilla
§ High palate
§ Deafness

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5
Q

Maternal Infection

A

Primary: Painless vulval/vaginal chancre, may not be noticed
High risk of fetal infection
Secondary:
- Fever, rash, hepatitis, lymphadenopathy
- Moderate risk of fetal infection
Latent:
- Asymptomatic
- <2 years: early
- >2 years: late
- Low risk of fetal infection
Tertiary:
- Cardiovascular, neurological, gummatous lesions
- Negligible risk of fetal infection

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6
Q

Fetal infection

A
  • Miscarriage
  • IUGR
  • Stillbirth
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7
Q

RANZCOG recommendations

A
  • Routine test at booking with Specific Treponemal assay and confirm with second assay (Remain positive for life following infection)
  • RPR performed to assess treatment success and reinfection
  • In high risk people: Consider retest in each trimester
    (Risk factors: Living in outbreak area, STI in prev 12/12, Hx prev Syphilis in prev pregnancy, IV drug use, women <29, remote areas, Indigenous or TSI women, multiple partners, parter has sex with other men, Partner from high prevalence country)
  • MDT: Obstetrics, Need infection to Infectious disease unit, Neonatal
  • Notifiable disease
  • Contact tracing
  • Penicillin 1,2MU each buttock 1 week apart x 2
  • Treat partner as well
  • avoid unprotected intercourse during period of treatment
  • If penicillin allergy: Desenstitise (Other treatments are not as effective and do not cross placenta well)
  • Repeat RPR titre monthly until delivery: Negative or 4 fold drop indicates successful treatment
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