Untreated syphilis in pregnancy is a very dangerous disease because it can lead to malformations of the fetus, and in some cases - even to its death. Early diagnosed congenital and acquired syphilis, however, can be successfully treated. Read what tests are done to diagnose syphilis in pregnant and newborn babies, how it manifests itself and how it is treated.

Syphilis (also known as syphilis) can also affect pregnant women. WHO warns that as many as 1.4 million women are infected with it all over the world1 , while the data of the National Institute of Hygiene from 2016 say about the birth of as many as sixteen newborns with congenital syphilis2 . This is a high number, because in Poland tests for the presence of syphilis in pregnancy are mandatory and free of charge - first at the beginning of pregnancy - in 9-10. a week, then on 33-37. week, is financed by the National He alth Fund. The test is carried out twice, because the infection of the fetus can occur through the placenta (so-called congenital syphilis) and during delivery (acquired syphilis) during the passage of the child through the birth canal.

Syphilis in pregnancy - how is syphilis infected in the fetus?

Congenital syphilis in the newborn

A child suffers from it when he became infected with syphilis in the womb. Bacteria of the pale spirochete enter the fetus through the placenta - the inflamed vessels of its villi. Infection can occur at any time during pregnancy, including when the placenta is not yet fully formed.

The diagnosis of congenital syphilis is not easy as more than half of the newborns do not develop symptoms right after delivery.

Congenital syphilis in newborns is early or late. Symptoms of early syphilis appear until the age of 2 (most often between 2 and 10 weeks of life), and syphilis later - after that time.

Early congenital syphilis in a newborn - symptoms:

  • liquid nasal discharge, leading to obstruction, and in some cases - permanent bone deformation;
  • convex frontal bones;
  • underdeveloped jaw bones;
  • inflammatory changes in the area of ​​cartilage and bones;
  • destruction of the epiphysis of the long bone;
  • jaundice;
  • anemia;
  • enlargement of the spleen and liver;
  • inertia of the lower limbs and contractureupper limbs (less frequently);
  • Parrot's scar - radiant scars that were formed as a result of the cracking of lumps around the mouth and anus.

Late congenital syphilis in a newborn - symptoms:

  • damage to the auditory nerve, in some cases leading to deafness;
  • saber drumsticks;
  • interstitial keratitis, in addition to tearing, light sensitivity, causing blindness;
  • recurrent joint effusions;
  • Hutchinson teeth - sunken and widely spaced upper incisors and molars with poorly developed and numerous cusps;
  • Fournier teeth - with apical decay.

Symptoms of late congenital syphilis only occur if early congenital syphilis has not been treated.

Acquired syphilis

Infection with acquired syphilis does not occur during pregnancy, but during labor, when the baby passes through the birth canal. Syphilis in children produces the same symptoms and works in the same way as syphilis in adults.

Worth knowing

How does a woman get syphilis?

Syphilis is infected sexually: during vaginal, oral or anal intercourse. They can also be caused by a kiss with a sick person if syphilitic changes have appeared in their throat. The spirochete bacteria ( Treponema pallidum ) are to blame for everything. Microorganisms enter the body through damaged mucous membranes or through damaged skin.

There is no vaccine against syphilis so far. Prophylaxis for this disease can help by using a condom and knowing the he alth condition of the sexual partner.

Syphilis in pregnancy is dangerous to the he alth and life of the fetus, both when a woman becomes infected with it while pregnant and in the case of a previous infection that has not been diagnosed and has not been treated.

Syphilis in a pregnant woman - symptoms

Syphilis in pregnant women is the same as in women who are not expecting a baby. Although men are more likely to suffer from syphilis than women, women are more difficult to spot the first symptoms than men, who are more pronounced and painful. The symptoms of syphilis in pregnancy vary depending on the severity of the disease.

Symptoms of primary syphilis in pregnancy

Syphilis in pregnancy in the primary stage shows symptoms about 3 weeks after infection, but it can also be 3 days or 3 months. We distinguish among them:

  • painless ulceration - most often appearing in an infected area, most often in the labia, but it can also occur oncervix, tongue, throat or lips. The ulcer does not hurt, resembles a round lump and disappears after a few weeks;
  • ulceration is most often accompanied by enlarged lymph nodes.

Unfortunately, the disappearance of the first symptoms of syphilis in pregnancy does not cure it, but the transition to the next stage - secondary syphilis.

Syphilis in pregnancy - symptoms of secondary syphilis

  • contagious rash - appears on the hands and feet in the form of spots and papules - disappears spontaneously;
  • flat condylomas - moist gray-white lesions appearing in wet places: under the breasts and around the vulva;
  • headache and throat pain;
  • fever;
  • lack of appetite;
  • meningitis (less common).

Symptoms of secondary syphilis appear approximately 3-6 weeks after the first symptoms of the disease. Then, untreated syphilis in pregnancy goes to the next stage - latent syphilis.

Syphilis in pregnancy - symptoms of latent syphilis and late syphilis

Late syphilis is the most dangerous stage of the disease and can show up within at least a year after infection.

Syphilis in the latent phase is asymptomatic. This is a very dangerous moment of the disease, occurring about a year after infection, when the sick person may mistakenly believe that his ailments have completely disappeared. Unfortunately, this is not the case, as the disease moves to the next stage - late syphilis. Late syphilis is manifested by diseases of the heart, brain, liver, organs of the nervous system, bones, joints, eyes.

Syphilis screening in pregnancy

Tests for the presence of syphilis in pregnancy are aimed at detecting the presence (or absence) of antibodies in the blood serum against pale spirochete antigens, i.e. the bacteria causing syphilis. Testing for syphilis in pregnancy involves taking blood from a vein and does not differ from the usual morphological tests - it does not require any special preparations, except for fasting. Blood sampling is best done 6 weeks after infection, because only after this time the bacteria are transferred to the blood.

Earlier, microscopic examination of secretions from the genitals, anus, throat or lips can be performed, although it is not common - this procedure allows you to identify pale spirochete infection before the bacterium reaches the blood, but laboratory tests are performed for confirmation.

The USR and VDRL screening tests are performed first, and if they reveal the presence of syphilitic bacteria in the blood, specific tests are performed to confirm infection. This is necessary because the USR and VDRL tests detect the presence of directed reagin antibodiesagainst lipid components of bacteria, and these are present in the serum also in other diseases, including thyroid diseases, chicken pox, pneumonia, lupus erythematosus. In the case of specific tests, the spirochete, Reiter and Nichols antigens are used to detect only syphilis bacteria. Syphilis-specific tests are FTA, FTA-ABS, TPHA and TPI.

You can read more about syphilis tests in pregnancy in the article: Syphilis tests - what tests detect syphilis and when to do them?

Treating syphilis in a pregnant woman

Treatment of syphilis in pregnancy is carried out around 20-24. week, as this period is considered to be the safest in the womb. The woman is given penicillin for about 20 days, which will not harm her or the baby. Treatment of syphilis in pregnancy can take place at any stage of the disease stage: in the case of primary, secondary, latent and late syphilis. Some treated women experience headache, muscle pain, joint pain and uterine contractions as a result of treatment, but these usually subside after a day.

Syphilis in pregnancy causes less blood flow to the fetus and inflammation of the placenta, so if left untreated, it can have serious consequences such as death of the fetus (as much as 40 percent of cases) or the death of the newborn (20 percent of cases) 3 .

Treatment of syphilis in the newborn

Treatment of syphilis in newborns, as in the case of pregnant women, consists in administering penicillin in appropriate doses. Crystalline penicillin is administered intravenously, and if allergic, erythromycin is used, but only in children over 1 month of age. All children with mothers diagnosed with syphilis during pregnancy are treated.

Sources:

1. World He alth Organization (WHO) data available at: http://www.who.int/reproductivehe alth/topics/rtis/syphilis/pregnancy/en/.

2. A detailed report presenting the incidence of syphilis (and other infectious diseases, as well as poisoning) is available on the website of the National Institute of Hygiene: http://wwwold.pzh.gov.pl/oldpage/epimeld/2016/index_mp.html.

3. Access to research by Dr. Meghana Phiske at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4066591/ [accessed on 12/01/2017].

Category:

Pregnant examinations