SYPHILLIS IN PREGNANCY TOG 2020 Flashcards
what % of sexual contacts become infected
33%(1/3rd)
what is the charcateristic lesion of syphillis
single genital painless indurated non purulent lesion
multilple and painful in extragenital sites
Whats the interval between infection and symptoms in primary syhillis
3 weeks ( 9-90 days)
what % of primary syphillis progress to secondary syphillis without treatment?
25% (1/4)
whats the interval between primary lesion and secondary disease?
4- 10 weeks
How would you describe the rash of secondary syphillis
genearlised muco-cutaneous rash of mucous membranes, also affecting the palms and soles,
condylomata lata- discoloured warty lesions arouns anal and genital areas
what is the natural history of secondary syphillis
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)
when is pregnancy is transmission common?
from 14 weeks of pregnancy( second trimester) due to transplacental spread
what percentage of fetuses die following syphillis infection in pregnancy
30-40%
what is the transmission rates in pregnancy
according to stage of the disease:
primary syphillis 100%
early latent phase (<12 months) 40%
Late latent phase (>12 months) 10%
what % of fetuses who survive are born with signs of congential syphillis?
1/3rd (33%)
what are the direct testing methods for syphillis?
Dark field microscopy
Polymerase Chain Reaction (PCR)
what are the types of serological testing for syphillis?
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
How often should you repeat testing in patients who refused testing at booking or who are at high risk for syphillis?
3 monthly
for patient at high risk who are negative at initial test, repeat at 6 weeks and 12 weeks, then 3 monthly
what is the most important factor influencing the risk of congenital infection and perinatal mortality?
initiation of treatment at least 30 days (4 weeks) before delivery
what is the preferred treatment regimen in non penicillin allergic patients
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)
what alternative treatment can be used in patient who cannot tolerate muscular injections or are allergic to penicllin?
Ceftriaxone 500mg daily IM for 10 days
Or Oral amoxycillin 500mg + probenicid 500mg QDS for 14 days
How common is Jarisch-Herxheimers in pregnancy?
in 45% of cases
50% in primary syphillis
90% in secondary syphillis
25% in late syphillis
What is the WHO criteria for elimination of congenital syphillis
< 0.5 cases per 1000
What % of congenital syphillis are asymptomatic
75% are asymptomatic at birth of which 75% of these, will have symptoms at 3-8 weeks of life
What are the common symptoms of congenital syphillis
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
what percentage of children > 2 years present with asymptomatic neurosyphillis?
25-33%
(1/4 to 1/3rd)
what is the likelihood of children born with congenital syphillis dying?
10% more likely to die within first year of life
In UK , according to recent data, what % of syphillis co-infection occurs with HIV infection ?
40%
