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Sunday, June 19, 2011

Pregnancy and Screening for Syphilis

Posted by Prahallad Panda on 8:15 PM Comments

As published in the BBC on 16th June 2011, Syphilis causes 500,000 stillbirths and newborn deaths globally, mostly in sub-Saharan Africa.

As published in Lancet about 2·1 million pregnant women have active syphilis every year. Without screening and treatment, 69% of these women will have an adverse outcome of pregnancy

 A photograph of Hutchinson’s Teeth resulting f...Image of Hutchinson's TeethHutchinson's teeth.Hutchinson's teeth.

Syphilis is a sexually-transmitted infectious disease. The bacterium Treponema Pallidum that cause it spread through broken skin or mucous membranes. Pregnant mothers infected with the disease can pass it to the baby developing in their womb. This is called congenital syphilis.

A study from University college of London showed screening and treatment resulted in a 58% decrease in stillbirths as well as a similar reduction in deaths in the first few weeks of life. Cases of congenital syphilis were also reduced.

Syphilis can cause still births, Low birth weight babies, death of new born and babies with classical stigmas of syphilis. Symptomatic newborns, if not stillborn, are born premature, with hepatosplenomegaly, skeletal abnormalities, pneumonia and a bullous skin disease known as pemphigus syphiliticus

Late congenital syphilis, when it occurs in children at or greater than 2 years of age who acquired the infection in mother's womb. may have Symptoms like;

  • Notched upper incisor teeth known as Hutchinson's teeth.
  • Inflammation of the cornea known as interstitial keratitis
  • Deafness from auditory nerve disease.
  • Frontal bossing (prominence of the brow ridge)
  • Saddle nose (collapse of the bony part of nose)
  • Hard palate defect.
  • Swollen knees.
  • Saber shins of tibia (A leg bone)
  • Short maxillae
  • Protruding mandible

A frequently-found group of symptoms is Hutchinson's triad, which consists of Hutchinson's teeth (notched incisors), keratitis and deafness and occurs in 63% of cases.

Mothers are usually screened for syphilis by their doctors in the early pregnancy, when they come for first check up.

Tests available are;

The first two tests are for screening purpose and the FTA-ABS test is confirmatory test for syphilis.

If a carrying mother found positive need to be treated adequately by her doctor. The antibiotic frequently used is penicillin and sometimes doxycycline.

The FTA-ABS test remains positive for life long, so lacks a treatment monitoring value. Similarly the screening tests may have false positive and false positive values.

Those can be false positive in diseases like;
  • Yaws
  • Pinta
  • Malaria
  • Certain Pneumonias
  • HIV
  • Systemic Lupus Erythematosus
  • and
  • Lyme disease

It will go a long way in preventing stillbirths or neonatal deaths due to syphilis, If all pregnant women were screened, and those who tested positive were treated with one dose of benzathine penicillin before 28 weeks' gestation.
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