Failure of recommended maternal therapy to prevent congenital syphilis

Article Abstract:

Syphilis is a sexually transmitted disease (STD) that can be passed from a pregnant mother to her unborn child; in the infant this condition is known as congenital syphilis. The incidence of congenital syphilis has been on the rise in recent years and is thought to be related to increased use of the drugs crack and cocaine. This study examined the case of a pregnant woman with syphilis, which was passed to her child. The mother came to the hospital two months prior to giving birth. She was diagnosed as having syphilis and was treated with a single dose of benzathine penicillin. When she gave birth, tests on blood from the baby's umbilical cord were negative for syphilis. The mother and child were released from the hospital two days later. At 10 weeks of age, the child was returned to the hospital and found to have congenital syphilis. The case was formally reviewed to see how this infection could have been prevented. The mother's initial treatment was clinically adequate according to present guidelines. However, she could have been reinfected from her partner if he was not treated. Tests on the baby were negative at birth and more extensive tests would probably have been negative. As a precaution, the child could have been treated anyway, but current guidelines do not recommend doing so. Recent research has shown that treating syphilis with benzathine penicillin can fail, and that how far along a pregnancy is when the mother is treated can determine whether or not the baby will become infected with the congenital form of the disease. New recommendations for treating pregnant women with syphilis are needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Prevention, Drug therapy, Communicable diseases, Pregnancy, Fetal diseases, Communicable diseases in pregnancy

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Comparison of maternal and newborn serologic tests for syphilis

Article Abstract:

Because an epidemic of congenital syphilis has developed in New York State, all newborns are required to be tested for syphilis. At delivery, either blood from the umbilical cord or maternal blood may be tested for syphilis, but it is unclear whether testing these two samples provides similar information. Studies of the reliability of such testing have not been reported in an organized fashion. To better understand the usefulness of testing cord and maternal blood samples, test results from 348 mothers and newborns, at least one of whom tested positively, were reviewed. In 33 percent of cases (115 patients), newborn cord blood was negative for syphilis while maternal blood was positive, while in 2 percent of cases maternal test results were negative and cord blood tested positive (7 infants). Of the 115 cases with positive maternal tests and negative cord tests, 67 infant blood samples were tested further; only 9 tested positive for syphilis. Of the seven cases with positive cord tests and negative maternal tests, four infant blood samples were tested further and only one tested positive for syphilis. In 100 cases with positive results from both maternal and cord blood, infant blood was tested further with 14 samples showing negative results. The findings support the ineffectiveness of testing of newborn cord blood for syphilis, as up to 33 percent of cases would not have been identified by this single test. Screening of maternal blood is the most effective way to detect infected mothers and newborns at risk for congenital syphilis, allowing appropriate treatment of both. (Consumer Summary produced by Reliance Medical Information, Inc.)

Testing, Infants (Newborn), Newborn infants, Syphilis, Fetal blood, Syphilis patients

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Maternal and congenital syphilis in Brooklyn, NY: epidemiology, transmission, and diagnosis

Article Abstract:

Congenital syphilis (CS) is on the rise, contributing to an increase in infant death and illness. CS is syphilis in infants, transmitted by an infected mother during pregnancy. Among 403 pregnancies in which syphilis was involved, 363 infants were live-born and 47 were stillborn. There were 75 cases of CS, 35 among the live-born infants and 40 among the stillborn. The 35 live-born infants with CS were evaluated for physical characteristics of CS and were given laboratory tests. Common physical findings such as rash and enlarged liver and spleen were present in only 12 of these infants, and the rest were diagnosed by abnormal laboratory results. Mothers were more likely to transmit syphilis to their infants if they had no prenatal care, were not treated for their own syphilis, or had a strong positive reaction to a blood test for syphilis, which may indicate a recent infection.

Causes of, Still-birth, Stillbirth

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