TORCH infections

Question 1

Vertical transmission HIV

Answer 1

• 30% risk of vertical transmission without treatment (vaginal birth)
• <2% risk of vertical transmission with modern HAART (vaginal birth reasonable if undetectable viral load)
• 1-5% risk with HAART + breastfeeding (not recommended)

Question 2

Vertical transmission Syphilis

Answer 2

• 100% primary infection
• 80% early latent infection
• 10% late latent infection
• 40% risk of congenital syphilis if infected and not treated
• 1-2% risk of congenital syphilis if infected and treated

Question 3

Vertical transmission of Listeria

Answer 3

High risk

Question 4

Fetal risks of maternal listeriosis?

Answer 4

• 40-50% mortality (miscarriage/IUFD) in T2/T3
• Preterm labour
• Meconium passage
• Perinatal listeriosis (3-60% mortality rate)

Question 5

Risk reduction of EOGBS in the neonate with intrapartum antibiotics?

Answer 5

80%

Question 6

Vertical transmission primary CMV

Answer 6

~30% risk of vertical transmission, overall risk of long-term sequelae is 10-20%

• 10-15% have symptomatic congenital CMV (50% risk of sequalae)
• 85-90% have asymptomatic congenital CMV (10-15% risk of sequalae –> hearing loss/chorioretinitis)
• Severe adverse neurological outcome more likely if primary infection within first 20 weeks

Question 7

Vertical Transmission Parvovirus

Answer 7

50%

Question 8

Risks of miscarriage/IUFD and hydrops with congenital parvovirus

Answer 8

Miscarriage/IUFD
- 10-15% if infected <20/40
- 2% if infected >20/40

Hydrops
- 3-10% if infected <20/40

Question 9

Vertical transmission primary HSV (vaginal birth)

Answer 9

25-50% (if <6/52 prior to delivery)

Question 10

Vertical transmission recurrent HSV (vaginal birth)

Answer 10

15% if HSV 1
<0.01% if HSV 2
(if active lesions at time of delivery)

Question 11

Vertical transmission Rubella

Answer 11

T1 - 80% (85% risk of congenital defects)
13-16/40 - 50% (35% risk of congenital defects)
17-30/40 - 30% (Defects rare)
31-36/40 - 60% (Defects rare)
>36/40 - ~100% (Defects rare)

Question 12

Vertical transmission Varicella Zoster

Answer 12

<12/40 - 0.5%
12-20/40 - 2%
12-28/40 - 1.4%
28/40 - 0%

Question 13

Vertical transmission Hep B (without intervention)

Answer 13

35%

Question 14

Vertical transmission Hepatitis C

Answer 14

~5% (mostly if high viral load and/or HIV co-infection)

Question 15

Vertical transmission Zika

Answer 15

10-25%

Question 16

Vertical transmission Toxoplasmosis

Answer 16

T1 - 10% (risk of defects 34-85%, likely to be severe)
T2 - 30% (risk of defects 20%, less severe)
T3 - >50% (risk of defects 10%, usually asymptomatic at birth)

Question 17

Risk of congenital malaria

Answer 17

1-4% of infants to non-immune infected mothers

0.3% of infants to immune infected mothers