Obstetrics - TORCHES Infection - Syphillis

Question 1

TORCHES Infection?

Syphilis?

What is it?

Transmission?

Answer 1

Caused by the spirochaete Treponema pallidum

Transmitted by sexual contact

Question 2

TORCHES Infection?

Syphilis?

Symptoms?

Answer 2

Infection occurs in three stages:

• Chancre - painless
• Disseminated disease - rash on palms and soles
• Cardiac and neurological involvement

Question 3

TORCHES Infection?

Syphilis?

Transmission?

Investigations?

Answer 3

Sexual Contact

Investigations:

Venereal Disease Research Lab (VDRL) test

Rapid plasma reagin test

Fluorescent treponemal antibody absorption test (FTA-ABS)

• Treponema pallidium* haemaggluntination test (TPHA)
• Trepomema pallidium* particle agglutination test (TPPA)

Treponemal enzyme immmunoassay (EIA)

Question 4

TORCHES Infection?

Syphilis?

Treatment?

Answer 4

Conservative:

• Education
• Advice on delivery route

Medical:

• Many antibiotics are contraindicated
• Local guidelines/BNF
• Termination

Maternal:

• Procaine penicillin G
• Doxycycline
• Erythromycin
• Azithromycin

Neurosyphilis:

• Prophylactic prednisolone
• To avoid Jarisch Herxheimer reaction

Fetal:

• Penicillin

Question 5

TORCHES Infection?

Syphilis?

Complications?

Answer 5

Fetal ABCDES:

• A - A small head (microcephaly)
• B - Brain pathology (meningitis), Bloodstained nasal discharge
• C - Choroiditis: inflammation of the choroid (thin pigmented vascular coat of the eye) and retina of the eye.
• D - Dental malformations, Deafness (sensorineural - damage to hair cells of cochlea)
• E - Enlarged liver and spleen

S - Skin lesions, Seizures