Syphilis in Pregnancy for Undergraduates Max Brinsmead MB
![Syphilis in Pregnancy for Undergraduates Max Brinsmead MB BS Ph. D May 2015 Syphilis in Pregnancy for Undergraduates Max Brinsmead MB BS Ph. D May 2015](https://slidetodoc.com/presentation_image_h2/f4a514115c351c1c3d09abb9ca09ae3c/image-1.jpg)
Syphilis in Pregnancy for Undergraduates Max Brinsmead MB BS Ph. D May 2015
![Syphilis l A sexually transmitted infection caused by the spirochetal bacterium Treponema pallidum Incubation Syphilis l A sexually transmitted infection caused by the spirochetal bacterium Treponema pallidum Incubation](http://slidetodoc.com/presentation_image_h2/f4a514115c351c1c3d09abb9ca09ae3c/image-2.jpg)
Syphilis l A sexually transmitted infection caused by the spirochetal bacterium Treponema pallidum Incubation period usually 14 – 28 days l Recognised in 3 stages in adults… l l Primary = typically a painless genital ulcer with non tender rubbery lymphadenopathy. Will be tender if 20 infection occurs. May go unrecognised l Secondary = Fever, rash, anorexia, aches & pains, and condyloma lata Occurs 2 – 8 weeks in only 1: 3 individuals after primary infection and resolves spontaneously l Tertiary = can affect any body organ including heart, bones and brain l Incidence l Rare in Australia except amongst indigenous population
![Tests for Syphilis l Screen using a serological test for reagin – a lipid Tests for Syphilis l Screen using a serological test for reagin – a lipid](http://slidetodoc.com/presentation_image_h2/f4a514115c351c1c3d09abb9ca09ae3c/image-3.jpg)
Tests for Syphilis l Screen using a serological test for reagin – a lipid released from cells that are attacked by T. pallidum l l Examples include VDRL and STS This test is sensitive and should revert to negative after treatment but… It is not positive until up to 12 w after infection l It is non-specific and there is a large number of conditions that cause a false positive test l l Tests that detect antibodies to Treponema (e. g FTA Abs) are more specific, appear before reagin but… Usually negative with the primary chancre l They are present for life even after successful treatment l Yaws (and Pinta) will also be positive to these tests l l Dark field microscopy of chancre fluid is possible & a number of tests can be done on this e. g. PCR or direct fluorescent antibody
![Syphilis in Pregnancy l Typically does not cross the placenta until >20 weeks l Syphilis in Pregnancy l Typically does not cross the placenta until >20 weeks l](http://slidetodoc.com/presentation_image_h2/f4a514115c351c1c3d09abb9ca09ae3c/image-4.jpg)
Syphilis in Pregnancy l Typically does not cross the placenta until >20 weeks l Fetal effects include… l Stillbirth l Intrauterine growth restriction l Prematurity l Neonatal effects include… l Hepatosplenomegaly l Pneumonia l Anaemia & Jaundice l Skin lesions l Osteochondritis
![Treatment of Syphilis l In the mother with a positive STS = serological test Treatment of Syphilis l In the mother with a positive STS = serological test](http://slidetodoc.com/presentation_image_h2/f4a514115c351c1c3d09abb9ca09ae3c/image-5.jpg)
Treatment of Syphilis l In the mother with a positive STS = serological test for syphilis l Give 3 doses of Benzathine penicillin 2. 4 m. U weekly l Erythromycin 500 mg 4 x daily for 15 – 30 days for true penicillin allergy l For a neonate l Adequate treatment >28 days before delivery should prevent neonatal syphilis l But “safety net” treatment commonly practised l 25, 000 IU/Kg Penicillin twice daily for 10 days l If the baby is clinically affected at birth the prognosis is poor – see paediatric texts for diagnosis & treatment l Ideally all babies born to STS-positive mothers should be followed with reagin tests until negative
![Follow-up and Contact Tracing l For a patient with a positive STS… l Contact Follow-up and Contact Tracing l For a patient with a positive STS… l Contact](http://slidetodoc.com/presentation_image_h2/f4a514115c351c1c3d09abb9ca09ae3c/image-6.jpg)
Follow-up and Contact Tracing l For a patient with a positive STS… l Contact and test/treat all partners for previous 12 m l Other children may require testing l Follow up by a specialist clinic by reagin testing is desirable to ensure that this test returns to negative – or titre stabilises after appropriate therapy is confirmed l It is desirable to document this and give this to the patient to present at future health encounters
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