SYPHILLIS IN PREGNANCY TOG 2020

Question 1

what % of sexual contacts become infected

Answer 1

33%(1/3rd)

Question 2

what is the charcateristic lesion of syphillis

Answer 2

single genital painless indurated non purulent lesion
multilple and painful in extragenital sites

Question 3

Whats the interval between infection and symptoms in primary syhillis

Answer 3

3 weeks ( 9-90 days)

Question 4

what % of primary syphillis progress to secondary syphillis without treatment?

Answer 4

25% (1/4)

Question 5

whats the interval between primary lesion and secondary disease?

Answer 5

4- 10 weeks

Question 6

How would you describe the rash of secondary syphillis

Answer 6

genearlised muco-cutaneous rash of mucous membranes, also affecting the palms and soles,
condylomata lata- discoloured warty lesions arouns anal and genital areas

Question 7

what is the natural history of secondary syphillis

Answer 7

Most resolve in 1-3 months ,
25% recurrence in early latent phase ( < 1 year)
30% progress to tertiary syphillis

It is the most common congenital infection worldwide (50% morbidity if untreated)

Question 8

when is pregnancy is transmission common?

Answer 8

from 14 weeks of pregnancy( second trimester) due to transplacental spread

Question 9

what percentage of fetuses die following syphillis infection in pregnancy

Answer 9

30-40%

Question 10

what is the transmission rates in pregnancy

Answer 10

according to stage of the disease:
primary syphillis 100%
early latent phase (<12 months) 40%
Late latent phase (>12 months) 10%

Question 11

what % of fetuses who survive are born with signs of congential syphillis?

Answer 11

1/3rd (33%)

Question 12

what are the direct testing methods for syphillis?

Answer 12

Dark field microscopy
Polymerase Chain Reaction (PCR)

Question 13

what are the types of serological testing for syphillis?

Answer 13

Treponemal serology:
1.Treponema pallidum particle agglutination assays( TPPA)
2. Treponema pallidum haemagglutination assay (TPHA)
3. Enzyme immunoassays (EIA)
4. Chemiluminiscence Immunoassay (CLIA)

Non treponemal serological tests: quantitative antibody test to monitor treatment
1.VDRL antigen test
2. Rapid plasma Reagen test

Question 14

How often should you repeat testing in patients who refused testing at booking or who are at high risk for syphillis?

Answer 14

3 monthly
for patient at high risk who are negative at initial test, repeat at 6 weeks and 12 weeks, then 3 monthly

Question 15

what is the most important factor influencing the risk of congenital infection and perinatal mortality?

Answer 15

initiation of treatment at least 30 days (4 weeks) before delivery

Question 16

what is the preferred treatment regimen in non penicillin allergic patients

Answer 16

IM Benzathine penicillin 2.4 MU stat in first trimester early disease and 2 doses a week apart in third trimester early disease ( 2 doses/ week x 2 doses)
Im Benzathine penicllin in all timesters for 3 doses a week apart in late disease( weekly for 3 doses)

Question 17

what alternative treatment can be used in patient who cannot tolerate muscular injections or are allergic to penicllin?

Answer 17

Ceftriaxone 500mg daily IM for 10 days
Or Oral amoxycillin 500mg + probenicid 500mg QDS for 14 days

Question 18

How common is Jarisch-Herxheimers in pregnancy?

Answer 18

in 45% of cases
50% in primary syphillis
90% in secondary syphillis
25% in late syphillis

Question 19

What is the WHO criteria for elimination of congenital syphillis

Answer 19

< 0.5 cases per 1000

Question 20

What % of congenital syphillis are asymptomatic

Answer 20

75% are asymptomatic at birth of which 75% of these, will have symptoms at 3-8 weeks of life

Question 21

What are the common symptoms of congenital syphillis

Answer 21

Early (<2 years of age): skin rashes, bloody snuffles( syphillitic rhinitis), monocytosis, thrombocytopenia, meningitis, hepatomegaly, raised alkaline phosphatase levels, jaundice, periostitis, severe anaemia
Late (> 2years) : bony deformities, Hutchinsons Triad: eight cranial nerve palsy, notched incisors and interstitial keratitis, saddle nose deformity (due to syphylitic rhinitis), “sabre shins’ from bowing of tibial bones

Question 22

what percentage of children > 2 years present with asymptomatic neurosyphillis?

Answer 22

25-33%
(1/4 to 1/3rd)

Question 23

what is the likelihood of children born with congenital syphillis dying?

Answer 23

10% more likely to die within first year of life

Question 24

In UK , according to recent data, what % of syphillis co-infection occurs with HIV infection ?

Answer 24

40%

Question 25

What is the prevalence of syphillis in UK between 2008-2018

Answer 25

1 in 700 to
1 in 7000
40% required antibiotic treatment

Question 26

What are the ultrasound features of fetal congenital syphillis infection?

Answer 26

Distorted fetal long bones or fetal hydrops
Hepatosplenomegaly
Intrahepatic calcification
Placentomegaly

Question 27

What % of fetal hydrops are associated with congenital infections ?

Answer 27

6-10%