Syphilis in Pregnancy

SYPHYLIS IN PREGNANCY
By Laston Kastom BscBMS(RH),Dip.Clin.Med
DEFINITION
Infection with a spirochete called Treponema pallidum. Spirochete are thin walled flexible, helical rods,
which have some features in common with bacteria- but unusual in that their mobility is due to internal
axial filaments rather than external flagellate used by other mobile bacteria. It is usually transmitted in
utero or via contaminated blood products or instruments.
These are four stages of syphilis disease.
 Primary
 Secondary
 Latent syphilis
 Tertiary syphilis
1. PRIMARY SYPHYLIS
It manifests with a chancre as a primary lesion, which occurs at the site of inoculation between 10 days
and three months
Chancre occurs on genitalia, around anus, it may also occur on lips, inside mouth, rectum or finger.
It is usually painless with indurated edges, and has a yellow base and harbours a large number of
spirochetes, which may be demonstrated by dark-ground microscopy. Lymphnodes may be enlarged
locally but are painless. The chancre heals spontaneously often without trace within 1-3 months.
2. SECONDARY SYPHYLIS
This occurs about 6 weeks to 8 weeks (2 months) after a chancre.
The patient usually has fever and presents with rush which is widespread and particularly involves the
genitalia, soles, palms and face, and this rush does not itch.
There is generalized painless lymphadenopathy. In some cases the primary chancre may still be present.
The initial rash is macular and pink (roscola) and is most obvious on trunk, then it becomes brown and
may resemble pityriasis rosea or psoriasis.
Later become infiltrated and annular configurations may occur.
On intertriginous areas the lesions may become eroded (condylomata lata )
Condylomata lata mainly occurs around anus or groin, but may occur under the axillae or breast, in
umbilicus or between toes.
These lesions are usually moist and exude treponemes in the serum, they are therefore highly
infectious.
There may be slightly raised oral patches with off-white eroded surface on mucous membranes, the
tongue, lip, soft palate are usually involved.
If you have several contagious lesions, they are known as snail track ulcers.
Hair loss is common, either as part of cutaneous eruptions or tolegen effluvium response to the systemic
upset.
The patient may be ill but most have some degree of malaise, headache, sore throat, horseness,
deafness, polyarthritis and nocturnal bone involvement.
Anaemia, leukocytosis and raised erythrocytes sedimentation rate (ESR) are common.
And at this stage, the serology tests are positive.
3. LATENT SYPHYLIS
If the infection is untreated it passes into latent stage- asymptomatic stage but with positive serology.
There are two phases for this stage.
Earlier latent phase occurs following secondary stage and this is when total duration of infection is less
than two years.
Late latent phase is when the total duration of infection is over two years or of indeterminate duration.
If this is not treated the disease will progress to tertiary syphilis, and in this stage there is involvement of
cardiovascular system or neuro-syphylis or other organ involvement.
4.TERTIARY SYPHYLIS
The gumma is the whole mark of this stage, a gumma is chronic granuloma which develops a number of
years after primary inoculation and is non infectious.
Dermal gummata are firm brownish-red papules or nodules, which are arranged in annular pattern and
are asymmetrical.
Their surfaces are smooth or scaly-resembling psoriasis and they heal with scar.
The subcutaneous lesions may break down and ulcerate with vertical punched out walls.
Lesions particularly occur on the upper shin, chest face and scalp.
Mucosal gummata may occur and tongue may be diffusely infiltrated with white patches, erosion and
fissuring.
Mucosal lesion may be premalignant.
5. CONGENITAL SYPHYLIS
This follows transplacental infection and the result depends on immunological maturity of the fetus and
the degree of infection
In Early pregnancy abortions or still births are very common.
The fetus may be cover in blisters.
If the pregnancy progresses, the child may be born with papules and blisters on the palms or soles.
Sometimes the child may develop secondary syphilis eruptions with hepato-spleenomegaly, pulmonary
and bone involvement.
Sometimes the child may be born normal but only develop failure to thrive.
Late congenital syphilis (presents with palate perforation, collapse of the nose, frontal bossing and tibia
bowing due to periostitis)
There may be nerve deafness, abnormal teeth and joint effusion and neuro-syphylis may eventually
result.
MANAGEMENT OF SYPHYLIS IN PREGNANCY
PRIMARY SYPHYLIS
A single dose of Benzathine penicillin 2.4 mu may be effective. If the patient is allergic to penicillin then
you may give Erythromycin 500mg q6hrs for 7 to 10 days, don’t use Deoxycycline during pregnancy.
SECONDARY SYPHYLIS
It is treated with Benzathine penicillin 2.4 MU IM once a week for three weeks. If the is allergic to
penicillin then use Erythromycin 500mg q6h for 15 days. Don’t use Deoxycycline in pregnancy.
LATENT SYPHYLIS
Treat with Benzathine penicillin 2.4 MU IM once for a week for three consecutive weeks. Give
Erythromycin 500mg qid for 30 days if the woman is allergic to penicillin. Don’t use DCN in pregnancy.
TERTIARY SYPHYLIS
Benzyl penicillin 3 MU IV q4hrs for 14 days, followed by Benzathine 2.4 MU IM once a week for three
weeks. If allergic to penicillin give Erythromycin 500mg q6hrs for thirty days. Don’t use DCN in
pregnancy.
CONGENITAL SYPHYLIS
Children under the age of 2 years usually respond well to adequate doses of penicillin, but recovery may
be slow in seriously ill patients.
You will give Benzathine penicillin 50,000units/kg start, followed by Benzyl penicillin 50,000 iu/kg IM/IV
q6hrs for 10 days.

Syphilis in Pregnancy

Uploaded by

Copyright:

Available Formats

Syphilis in Pregnancy

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Syphilis in Pregnancy

Uploaded by

Copyright:

Available Formats

SYPHYLIS IN PREGNANCY

By Laston Kastom BscBMS(RH),Dip.Clin.Med

These are four stages of syphilis disease.

This occurs about 6 weeks to 8 weeks (2 months) after a chancre.

Later become infiltrated and annular configurations may occur.

On intertriginous areas the lesions may become eroded (condylomata lata )

And at this stage, the serology tests are positive.

There are two phases for this stage.

In Early pregnancy abortions or still births are very common.

The fetus may be cover in blisters.

MANAGEMENT OF SYPHYLIS IN PREGNANCY

You might also like

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.