Syphyllis Flashcards
Positive syphillis
Vdrl and/or for titre +
Treponema test: FTA-Abs and/or TPPA/TPHA +
Past treated/latent infection
Vdrl and/or RPR titre -
Treponema test: tppa/tpha and fta abs +ve
Primary infection
Chancre (painless)
Risk of fetal infection high
Begins 21 days and lasts 2-6 weeks
60-100% risk of transmission
Secondary infection
Systemic illness including fever, rash, hepatitis, lymphadenopathy, meningoencephalitis
Moderate risk of fetal infection
Infection rate 60-100%
Latent infection
Asymptomatic
<2years - early; >2 years - late
Risk of fetal infection low
40% early; 8% late
Tertiary
Cardiovascular
Neurological
Gummatous lesions
Risk of fetal infection negligible
Treatment
Procaine penicillin or beneath one penicillin
Repeat monthly vdrl or rpr monthly until delivery
Treat early (at least30 days before delivery)
Decrease risk of transmission to 1-2%
If congenital syphilis is a possibility perform all of the following
Infant serology (IgM, RPR - with mat serology)
Full clinical exa
Placental histopathology +/- PCR
High risk women
Screen every trimester
Incubation period
10-90 days
Pathogenesis
Immune modulated
Apoptosis change
Increased production of inflammatory cytokines and TNF-a and prostaglandins induced by uterine infection has been associated with fetal demise and FGR
VDRL positive
Perform TPPA test
Both positive - syphillis
If TPPA negative, retest in 4 weeks
Vertical transmission timing
ANY time in pregnancy
Neonatal management
Test IgM if risk congenital infection
PCR if symptomatic neonate
If high risk, review at 3 months
If positive TPPA but negative at 3 months, need a repeat test at 15-18 months
Long term hearing screening up to 2 years
Risk to baby
Prem birth
LBW
SM
Perinatal death
Physical malformations: osetophytic changes in bones
Dental deformities, intellectual impairment, keratitis, sensorineural hearing loss, hydrocephalus
