Syphilis in pregnancy

Question 1

Incidence in Australia

Answer 1

18.3/100 000 people

women: 15.9/100 000 in 15-19 year
15.1/100 000 in 20-24 year
13.7 /100 000 in 25 to 29 years

Incidence is 40x higher in indigenous and TSI women
Higher incidence in remot areas

Question 2

Congenital Infection

Answer 2

Occurs transplacentally and can be transmitted even in latent or tertiary stage

Question 3

Clinical relevance

Answer 3

Early untreated syphilis will result in congenital infection in 70-100% of neonates
Still birth 30%

Question 4

Early Neonatal signs

Answer 4

Hydrocephalus
Characteristic skin lesions
Lymphadenopathy
HSM
FTT
Meningitis
Seizures
Mental impairment
Osteochondritis
Pseudoparalysis
- Some signs may only be seen closer to age 2 years
Later signs of congenital syphilis
o Late congenital syphilis (after 2 years)
§ Blunted upper incisors
§ Gummatous ulcers
§ Frontal bossing
§ Short maxilla
§ High palate
§ Deafness

Question 5

Maternal Infection

Answer 5

Primary: Painless vulval/vaginal chancre, may not be noticed
High risk of fetal infection
Secondary:
- Fever, rash, hepatitis, lymphadenopathy
- Moderate risk of fetal infection
Latent:
- Asymptomatic
- <2 years: early
- >2 years: late
- Low risk of fetal infection
Tertiary:
- Cardiovascular, neurological, gummatous lesions
- Negligible risk of fetal infection

Question 6

Fetal infection

Answer 6

• Miscarriage
• IUGR
• Stillbirth

Question 7

RANZCOG recommendations

Answer 7

• Routine test at booking with Specific Treponemal assay and confirm with second assay (Remain positive for life following infection)
• RPR performed to assess treatment success and reinfection
• In high risk people: Consider retest in each trimester
  (Risk factors: Living in outbreak area, STI in prev 12/12, Hx prev Syphilis in prev pregnancy, IV drug use, women <29, remote areas, Indigenous or TSI women, multiple partners, parter has sex with other men, Partner from high prevalence country)
• MDT: Obstetrics, Need infection to Infectious disease unit, Neonatal
• Notifiable disease
• Contact tracing
• Penicillin 1,2MU each buttock 1 week apart x 2
• Treat partner as well
• avoid unprotected intercourse during period of treatment
• If penicillin allergy: Desenstitise (Other treatments are not as effective and do not cross placenta well)
• Repeat RPR titre monthly until delivery: Negative or 4 fold drop indicates successful treatment