CONGENITAL SYPHILLIS

It is a serious debilitating and disfiguring condition that can be fatal. About one third of syphilis infected mothers have adverse pregnancy outcome, one third give birth to a healthy baby, while the remaining third may result into congenital
syphilis infection.

Cause

  • Treponema pallidum bacteria

Clinical features

  • May be asymptomatic
  • Early congenital syphilis: begins to show after 6-8 weeks of delivery
    • Snuffle, palmar/plantar bullae, hepatosplenomegaly, pallor, joint swelling with or without paralysis and cutaneous lesions. These signs are non-specific.
  • Late congenital syphilis: begins to show at 2 years
    • Microcephaly, depressed nasal bridge, arched palate, perforated nasal septum, failure to thrive, mental sub normality and musculoskeletal abnormalities

Investigations

Preferably perform the tests on mother:

  • VDRL/RPR
  • TPHA

Management of congenital syphilis

  • Assume cerebrospinal involvement in all babies less than 2 years
  • Aqueous benzylpenicillin 150,000 IU/kg body weight IV every 12 hours for a total of 10 days
  • OR procaine penicillin, 50,000 IU/kg body weight, IM single dose daily for 10 days
  • Treat both parents for syphilis with benzathine penicillin 2.4 MU single dose (half on each buttock)

Note

  • Assume that infants whose mothers had untreated syphilis or started treatment within 30 days of delivery have congenital syphilis
  • If mother is diagnosed with syphilis during pregnancy, use benzathine penicilln as first line since erythromycin does not cross the placental barrier and therefore does not effectively prevent in utero acquisition of congenital
    syphilis
  • Do not use doxycycline in pregnancy

Prevention

  • Routine screening and treatment of syphilis infected mothers in antenatal clinics