Syphilis in pregnancy Flashcards
Incidence in Australia
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
Congenital Infection
Occurs transplacentally and can be transmitted even in latent or tertiary stage
Clinical relevance
Early untreated syphilis will result in congenital infection in 70-100% of neonates
Still birth 30%
Early Neonatal signs
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
Maternal Infection
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
Fetal infection
- Miscarriage
- IUGR
- Stillbirth
RANZCOG recommendations
- 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