Congenital syphilis - breaking through the safety net

Article Abstract:

An article in the November 8, 1990 issue of The New England Journal of Medicine shows that, even with modern diagnostic methods, some cases of syphilis among newborn babies are not detected. The mothers of the seven babies in this study lived in an area where syphilis was not uncommon, but none of the infants tested positive at birth. This was probably because the mothers had been infected too close to the time of delivery for a test to show a positive result. These findings, from only one hospital, suggest a problem of vast proportions. In fact, news regarding venereal disease seems almost uniformly negative. However, closer examination of epidemiologic data allows certain patterns to be observed. Some diseases, such as gonorrhea, are now declining in incidence. The incidence of others, such as syphilis, has dramatically increased. In New York City, the number of cases of congenital syphilis in 1986 was 57; in 1988 it was 357; and the projected number for 1989 is approximately 950. Current screening recommendations from the Centers for Disease Control include testing during the last trimester of pregnancy for high-risk women, follow-up after treatment is administered, and, in high-prevalence areas, screening at delivery. In fact, the latter is now required in New York State. The elimination of congenital syphilis will occur only after several problems have been addressed. These include drug addiction, the spread of the disease among adults, and the provision of prenatal care to all pregnant women. Ultimately, pediatricians must know how to recognize children whose mothers are at risk, and how to diagnose the disease. Physicians must maintain a high level of suspicion and be prepared to give penicillin in situations where there is doubt, but where the benefits outweigh the risks. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Diagnosis, Demographic aspects, Medical screening, Health screening, Syphilis, Congenital, hereditary, and infantile, Congenital syphilis

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Clearance of HIV - lessons from newborns

Article Abstract:

The case of a five-year-old boy who was infected with HIV at birth but appears to have cleared the infection indicates that the human immune system in some cases can fight off the infection. The boy was born to an HIV-infected woman and tested positive for HIV at 19 and 51 days, but not at one year or subsequent years. There have also been other reports of infants clearing the virus shortly after birth. Other researchers have found evidence of immune system activation against HIV in infants of HIV-positive women, but the infants never became infected. It is likely that they were exposed to the virus in the uterus and may have received protective antibodies from the mother. Many researchers believe an infant's immune system is too weak to fight a viral infection of this magnitude. If not, the implications of this case could lead to more effective vaccines to prevent transmission of the virus in other settings.

Prognosis, HIV infection, Diseases, Infants (Newborn), Neonatal diseases

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Short (and shorter) courses of zidovudine

Article Abstract:

One study shows that zidovudine is effective in preventing maternal-fetal transmission of HIV, even when administered during labor, and even when administered to the newborn within 48 hours of birth. The first question raised by this is the validity of the study, given the changing nature of obstetrics during the two years of the survey. The second question in treatment of the infant alone is how long should it be continued with infants who are not breast fed? There is also a question concerning treatments to the mother enhancing treatments to the infant.

Health aspects, Maternal-fetal exchange, Prevention, HIV infection in children, Pediatric HIV infections, Disease transmission, Pregnancy, Zidovudine, HIV infection in pregnancy

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