In Utero Infection with Treponema Pallidum in Early Pregnancy

Nathan, Lawrence; Bohman, Van R.; Sánchez, Pablo J.; Leos, N. Kristine; Twickler, Diane M.; Wendel, George D.

doi:10.1097/00006254-199710000-00001

Cited by 15 publications

(30 citation statements)

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“…Until recently, a commonly held but erroneous obstetric principle stated that infection of the fetus does not occur before 18 weeks. 22 Silver and immunofluorescence staining of the fetal tissue, 23 or polymerase chain reaction and rabbit infectivity testing of amniotic fluid 24 showed that T pallidum gains access to the fetal compartment as early as 9-10 weeks. Untreated syphilis during pregnancy can profoundly aVect pregnancy outcome, resulting in spontaneous abortion, stillbirth, non-immune hydrops fetalis, intrauterine growth restriction, premature delivery, and perinatal death, as well as serious sequelae in liveborn infected children.…”

Section: Epidemiologymentioning

confidence: 99%

Syphilis in pregnancy

Genç¹

2000

Sexually Transmitted Infections

174

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Syphilis can seriously complicate pregnancy and result in spontaneous abortion, stillbirth, nonimmune hydrops, intrauterine growth restriction, and perinatal death, as well as serious sequelae in liveborn infected children. While appropriate treatment of pregnant women often prevents such complications, the major deterrent has been inability to identify the infected women and get them to undergo treatment. Screening in the first trimester with non-treponemal tests such as rapid plasma reagin (RPR) or venereal disease research laboratory (VDRL) test combined with confirmation of reactive individuals with treponemal tests such as the fluorescent treponemal antibody absorption (FTA-ABS) assay is a cost eVective strategy. Those at risk should be retested in the third trimester. Treatment during pregnancy should be with penicillin. In determining a penicillin regimen, the clinician must consider the stage of the maternal infection and the HIV status of the mother. Patients who are allergic to penicillin should be desensitised before treatment. Despite appropriate treatment, as many as 14% will have a fetal death or deliver infected infants. Treatment may further be complicated by the Jarich-Herxheimer reaction, a complex allergic response to antigens released from dead micro-organisms, which can cause fetal distress and uterine contractions. Thanks to eVective intervention strategies and inexpensive penicillin, syphilis rarely complicates pregnancy in the Western world today. In parts of the world where the traditional sexually transmitted diseases have not been controlled, the magnitude of problems associated with syphilis during pregnancy is reminiscent of that faced by the West during the early 1900s. (Sex Transm Inf 2000;76:73-79)

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Section: Epidemiologymentioning

confidence: 99%

Syphilis in pregnancy

Genç¹

2000

Sexually Transmitted Infections

174

View full text Add to dashboard Cite

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“…Then the samples were administered to rabbits in the dose of from 5 to 10 ml and tested in polymerase chain reaction (PCR). T. pallidum was detected in amniotic fluid by biological rabbit test in 36% of cases, while treponemal DNA was found in 27% [6].…”

Section: Introductionmentioning

confidence: 98%

“…Complex immunobiological processes initiated by infecting agent determine further development of the infection in newborn children [5][6][7]. The problem of studying syphilis in pregnant women and improving medical and preventive measures has gained particular relevance in Ukraine recently.…”

Section: Introductionmentioning

confidence: 99%

“…The influence of syphilis upon the course and the outcome of a pregnancy depends on the terms of infection and pregnancy when the woman was infected [4,6]. It was considered earlier that the only way of transmitting syphilis from mother to newborn was transplacental.…”

Section: Introductionmentioning

confidence: 99%

“…It was considered earlier that the only way of transmitting syphilis from mother to newborn was transplacental. Recent data suggest Treponema pallidum gets into the fetus's organism at a quite early stage (starting with weeks 9-10 of pregnancy) though pathologic changes in its organs and tissues can be detected only in the months 5-6 of pregnancy [6,7]. Determining T. pallidum in amniotic fluid has proved the possibility of fetus infection at early stages of pregnancy.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Clinical and Epidemiological Features of Syphilis in Pregnant Women: The Course and Outcome of Pregnancy

Мавров¹,

Goubenko²

2001

Gynecol Obstet Invest

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Clinical and epidemiological features of syphilis and the course and outcome of pregnancy were studied in 155 pregnant women infected with syphilis; 95 (61%) women were unemployed, 47% were unmarried. Syphilis proceeded without clinical manifestations in 121 cases (78%). Discordant results of complement fixation (Wassermann) test, precipitation test, Treponema pallidum immobilization test, and fluorescent antibody test were observed in 22 (14%) of the women. Pregnancy pathology was observed in 75 cases (48.8%) and more often appeared as anemia in 49 (31.5%), stillborn in 46 (29.8%) and toxicosis in 44 (28.4%). Fetal ultrasonic stigmas of infection were evident in 23 cases (49%). There was distension of the brain ventricle system and hepatomegaly each in 1 case (2%), transvascular infiltration of liver in 2 cases (4%), dilation of intestinal loops, gastromegaly, ventriculomegaly and petrifaction in lungs each in 1 case; ultrasonic changes in vessels of organs: of the liver in 4 cases (8%), intestines and stomach in 16 cases (32%), lungs in 4 cases (8%), kidneys in 10 cases (21%) and of the ventricular system in 9 cases (19%). Fetus development retardation was revealed in 3 cases (6%), fetal hypoxia in 1 (2%), hypohydrosis in 2 (4%) and hydropsy in 1 case (2%). The pregnancy pathology in women with syphilis was considered not pathognomonic.

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Congenital syphilis: A contemporary update on an ancient disease

2020

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Congenital syphilis (CS) rates reached a 20-year high in the United States in 2018. Unlike previous years, most babies diagnosed with CS were born to mothers who received prenatal care, indicative of the need for better provider education and guideline adherence. Current rates suggest that screening for syphilis should be performed at the first prenatal care visit and twice during the third trimester. There are two diagnostic algorithms available for use in the United States (traditional and reverse) and providers must understand how to perform each algorithm. Treatment should be administered according to stage of syphilis per Centers for Disease Control recommendations with best neonatal outcomes seen when treatment is initiated >30 days before delivery. Benzathine Penicillin G remains the only recommended treatment of syphilis during pregnancy. In viable pregnancies, a pretreatment ultrasound is recommended to identify sonographic evidence of fetal infection and treatment should be initiated with continuous fetal monitoring to evaluate for the Jarisch-Herxheimer reaction which can cause preterm labor and fetal distress. After adequate syphilotherapy, a fourfold decline in maternal nontreponemal titers may not be observed by delivery and does not correlate with rates of CS.

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In Utero Infection with Treponema Pallidum in Early Pregnancy

Cited by 15 publications

References 0 publications

Syphilis in pregnancy

Syphilis in pregnancy

Clinical and Epidemiological Features of Syphilis in Pregnant Women: The Course and Outcome of Pregnancy

Congenital syphilis: A contemporary update on an ancient disease

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