Congenital syphilis--missed opportunities for prenatal intervention

Abstract

The practice of STI treatment among chemists and druggists in Pokhara, NepalChemists and druggists working in "medical shops" play a significant part in the treatment of sexually transmitted infections (STIs) in resource poor countries. [1][2][3][4] In some settings, chemists and druggists are consulted for first line treatment of STI symptoms more often than hospitals and clinics designed specifically to service such clients.1 Recent unpublished data from Pokhara, Nepal, suggest that in up to 80% of cases, treatment provided by chemists and druggists was inappropriate or incomplete. 1 We report here on the quality of STI case management among a random sample of chemists and druggists from the 75 medical shops in Pokhara Municipality Area, Nepal.Chemists and druggists working in all Pokhara medical shops, 65% of whom had received previous training in the national STD case management guidelines, 5 based on WHO syndromic algorithms, 6 were trained and motivated to initiate a register of all STI client visits and their treatment. Registry data from January to December 1999 were reviewed. Thirty seven registered medical shops were randomly selected for visits using the simulated client method (SCM) presenting 22 urethral discharge (UD) and 15 vaginal discharge (VD) scenarios.Of the 6374 STI cases (68% female, 32% male), 22% presented with urethral discharge, 31% with vaginal discharge, 21% with genital ulcer disease, and 26% with pelvic inflammatory disease. Seventy per cent of STI shop clients were making their first contact for care, while 14% were coming to buy STI drugs with a prescription from a private clinic and 16% from a government facility.Based on SCM visits, only 24% of shops dispensed the correct medication and dosage for treatment of UD and VD, as specified in the national guidelines. Frequency of dispensing either an overdosage or an incomplete dosage of the correct medication was the same (both 5%). In 43% of cases, chemists and druggists offered treatment that was incompatible with national guidelines, including drugs not meant for UD or VD treatment. Finally, in 22% of cases no medication was dispensed (fig 1). While over 95% of SCM clients were made to feel welcome, given a private consultation, and were asked about their health history, risk counselling was conducted only 57% of the time, partner notification occurred in 43% of cases, and condom use was promoted in only 35% of cases.Seventy per cent of clients visiting medical shops for STI treatment in Pokhara Municipality Area in 1999 were there for first line treatment-findings in agreement with a recent study conducted in Ghana, which found that over 60% of STI clients came to pharmacies without a prescription. 3Although positive privacy and welcoming practices make medical shops a valuable outlet for STI treatment, only one quarter of chemists and druggists in Pokhara Municipality Area correctly dispensed medication for the treatment of UD or VD. While these data do not permit analysis of whether trained versus untrained providers were b...

Congenital Syphilis

“…Other findings include rhinitis, hepatosplenomegaly, lymphadenopathy, and failure to thrive. Anemia (present in our patient) leukocytosis, thrombocytopenia, hypoproteinemia, hypoalbuminemia, hyperbilirubinemia, and elevated liver enzyme levels can occur (6). Multisystem failure from overwhelming treponemal sepsis also has been reported (7).…”

Early congenital syphilis presenting with skin eruption alone: a case report

“…In addition, symptoms of early congenital syphilis include fever, failure to thrive, hepatosplenomegaly, lymphadenopathy, osteochondritis, pneumonitis, and rhinitis 6) . Leukocytosis, Coombs-negative hemolytic anemia, thrombocytopenia, hypoproteinemia, hypoalbuminemia, hyperbilirubinemia, and elevated liver enzyme levels may be present 6 , 9) . Because these laboratory findings are difficult to identify upon physical examination, a high index of suspicion is necessary to make the right diagnosis early.…”