SYPHILIS DURING

PREGNANCY
We will discuss:

 Definition
 Causative organism
 Mode of transmission
 Incubation period
 Clinical picture:
o Acquired syphilis
o Congenital syphilis
 Diagnosis
 Treatment
 Prognosis
DEFINITION

• Syphilis is a sexually transmitted disease (STD) caused by the spirochete

Treponema pallidum.
Treponema pallidum:

• is a fragile spiral bacterium 6-15 micrometers long by 0.25 micrometers in

diameter.
• Its small size makes it invisible on light microscopy; therefore, it must be
identified by its distinctive movements on darkfield microscopy.
• It can survive only briefly outside of the body; thus, transmission almost always
requires direct contact with the infectious lesion.
• T pallidum is a labile organism that cannot survive drying or exposure to
disinfectants; thus, fomite transmission (e.g., from toilet seats) is virtually
impossible
MODE OF TRANSMISSION
• acquired syphilis :
 sexual contact with infectious lesions
 via blood product transfusion (if blood has been collected during early
syphilis)
 occasionally through breaks in the skin that come into contact with
infectious lesions.
• Congenital syphilis: from mother to fetus in utero
INCUBATION PERIOD

• Incubation time from exposure to Treponema pallidum to development of

primary lesions, which occur at the primary site of inoculation
• T pallidum rapidly penetrates intact mucous membranes or microscopic
dermal abrasions and, within a few hours, enters the lymphatics and blood
to produce systemic infection
• In acquired syphilis, range from 10-90 days with averages 3 weeks
CLINICAL PICTURE

• acquired syphilis: there are 4 stages :

1. Primary syphilis
2. Secondary syphilis
3. Latent syphilis: early, late
4. Tertiary syphilis
• Congenital syphilis
Primary syphilis

• Primary syphilis occurs 10-90 days after contact with an infected individual.
• It manifests mainly on the glans penis in males and on the vulva or cervix in females.
• 10% of syphilitic lesions are found on the anus, fingers, oropharynx, tongue, nipples, or
other extragenital sites.
• Regional nontender lymphadenopathy follows invasion.
• Lesions (chancres) usually begin as non painful solitary, raised, firm, red papules that can
be several centimeters in diameter. The chancre erodes to create an ulcerative crater within
the papule, with slightly elevated edges around the central ulcer.
• It usually heals within 4-8 weeks, with or without therapy.
Secondary syphilis
• Secondary syphilis manifests in various ways.
• Mild constitutional symptoms of malaise, headache, anorexia, nausea,
aching pains in the bones, and fatigue often are present, as well as fever
and neck stiffness
• It usually presents with a cutaneous eruption within 2-10 weeks after the
primary chancre generally nonpruritic and bilaterally symmetrical and are
distributed widely with frequent involvement of the palms and soles with
generalized nontender lymphadenopathy is typical
Secondary syphilis:
Latent syphilis

• Latent syphilis is divided into early latent and late latent. The distinction is important
because treatment for each is different.
• The early latent period is the first year after the resolution of primary or secondary syphilis.
• Late latency syphilis is not infectious; however, women in this stage can spread the disease
in utero
• Latency may last from a few years to as many as 25 years before the destructive lesions of
tertiary syphilis manifest.
• Affected patients asymptomatic during the latent phase, and the disease is detected only by
serologic tests.
Tertiary syphilis

• The lesions of gummatous tertiary syphilis usually develop within 3-10 years of infection
• Tertiary (late) syphilis is slowly progressive and may affect any organ.
• The disease is generally not thought to be infectious at this stage.
• A gumma is a soft, non-cancerous growth and it is a form of granuloma. Gummas are most commonly found in
the liver (gumma hepatis), but can also be found in brain, heart, skin, bone, testis, and other tissues, leading to a
variety of potential problems
• Manifestations may include the following:
 Impaired balance, paresthesias, incontinence, and impotence
 Focal neurologic findings, including sensorineural hearing and vision loss
 Dementia
 Chest pain, back pain, stridor, or other symptoms related to aortic aneurysms
Tertiary syphilis
COMPLICATIONS

• Complications of syphilis may include the following:

1. Cardiovascular disease - Aortic aneurysm
2. CNS disease - Dementia, stroke
3. Membranous glomerulonephritis
4. Paroxysmal cold hemoglobinemia
5. Irreversible end-organ damage
6. Disfigurement by gummas
Congenital syphilis

• Trans placental from infected mother to fetus or at the birth

• Congenital syphilis is associated with several adverse outcomes as LBW,
premature at birth, miscarriage, congenital anomalies or death of baby.
 Congenital syphilis

o Early congenital syphilis o Late congenital

syphilis
occurs within the first 2 years of life. emerges in children older than 2 years.
1. Rhinitis (snuffles) which is highly infectious 1. Gummatous ulcers
2. Skin lesion: maculopapular rash 2. Bony prominence on for head
3. Lymphadenopathy 3. Saddle nose
4. Hepatosplenomegaly 4. Short maxilla
5. Failure to thrive 5. Hutchinson's triad: interstitial
6. Jaundice, anemia keratitis, 8 nerve deafness and dental
7. osteochondritis deformities
Congenital syphilis
DIAGNOSIS

• T pallidum cannot be cultivated in vitro and is too small to be seen under

the light microscope.
• Serologic testing is considered the standard method of detection for all
stages of syphilis
first perform nontreponemal serology screening using:

1. the Venereal Disease Research Laboratory (VDRL)

2. rapid plasma reagin (RPR)
treponemal test:

• Because of the possibility of false-positive results, confirmation for any positive or

equivocal nontreponemal test result should follow with a treponemal test, such as:
1. the fluorescent treponemal antibody-absorption (FTA-ABS)
2. microhemagglutination assay T pallidum (MHA-TP)
3. T pallidum hemagglutination (TPHA)
4. T pallidum particle agglutination (TPPA) tests.
5. Treponemal enzyme immunoassay (EIA) for immunoglobulin G (IgG) and
immunoglobulin M (IgM) may be performed
Darkfield microscopy:

• is a possible mode of evaluating moist cutaneous lesions, such as the

chancre of primary syphilis or the condyloma lata of secondary syphilis
Others:

• Imaging Studies: depending on the organ system involved. For example,

granulomatous disease of the liver can be seen on computed tomography
(CT) of the abdomen.
• Lumbar puncture: in individuals with late latent syphilis if treatment
fails or if neurologic or ocular symptoms are present .It is also indicated if
there are other changes indicative of tertiary syphilis (e.g., gumma,
aortitis).
TREATMENT

• PENICILLIN IS THE DRUG OF CHOICE TO TREAT

SYPHILIS.
The following regimens are recommended for penicillin treatment:

• Primary or secondary syphilis - Benzathine penicillin G 2.4 million units

intramuscularly (IM) in a single dose
• Early latent syphilis - Benzathine penicillin G 2.4 million units IM in a
single dose
• Late latent syphilis or latent syphilis of unknown duration - Benzathine
penicillin G 7.2 million units total, administered as 3 doses of 2.4 million
units IM each at 1-week intervals
• Pregnancy - Treatment appropriate to the stage of syphilis is recommended.
patients allergic to penicillin:

• they currently are recommended only as alternative treatment regimens in

patients allergic to penicillin. A 10- to 14-day trial of ceftriaxone is
effective for treating early syphilis, although the optimal dose and
duration have not been established.
• Doxycycline and tetracycline for 28 days have been used for many years
and are the only acceptable alternatives to penicillin for the treatment of
latent syphilis. Doxycycline is the preferred alternative to penicillin owing
to its tolerability.
Surgical Care

• Surgical care is reserved for treating the complications of tertiary syphilis

(e.g., aortic valve replacement).
PROGNOSIS

• For patients diagnosed with either primary or secondary syphilis (without

auditory/neurologic/ocular involvement), the prognosis is good following
appropriate treatment T pallidum remains highly responsive to the
penicillins, and cure is likely.
• Overall prognosis for tertiary syphilis depends on the extent of scarring
and tissue damage, as treatment arrests further damage and inflammation
but cannot reverse previous tissue damage
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Thank you