Complications of Pregnancy

Syphilis in Pregnancy
By Sophie Ndemo
BScN, UoN
Syphilis in Pregnancy
• Syphilis is a complex disease caused by Treponema pallidum
• It has the potential to cause serious congenital disease and appears to
enhance the transmission of human immunodeficiency virus (HIV).

Mode of transmission
• Syphilis is typically transmitted sexually or congenitally.
• Rare cases of acquisition through contaminated blood products have been
reported.
• Syphilis can also be spread by skin or mucosal contact with an infectious
lesion (e.g. through nonsexual direct contact such as skin to skin or
kissing).
• Clinical features in the mother
•Most pregnant women with syphilis have no clinical signs, hence the
need for routine screening in pregnancy.
•The incubation period averages 14-28 days after exposure, before
development of primary chancre. However it can be as long as 90 days.
The clinical features vary according to the stage of syphilis.
•What are the stages of syphilis?
Prevention of Mother to Child Transmission of Syphilis

•Providers of maternal and neonatal health care in particular skilled

attendants must:
 Screen all pregnant women for syphilis at the first ANC visit
 Review test result at subsequent visits and at time of delivery
 Offer syphilis screening after delivery to all those not screened during
pregnancy
 Treat all sero reactive women
 Contact tracing and treatment of partners
 Counsel sero negative women to remain negative
 Treat women with clinical disease or history of exposure
 Offer voluntary counselling and testing of HIV to all
woman who test positive for syphilis
 Screen for other STIs
 Plan for treatment of baby at birth
 Record testing results and treatment in the facilities
register and the Mother Child booklet
Congenital Syphilis
•Symptoms usually develop 2-8 weeks after birth.
•Symptoms and signs:
1. Generalized edema
2. Skin lesions include: Skin rash, blisters on palms and soles, shiny scaly
erythema on palms and soles
3. Mucous membrane lesions include snuffles which make suckling
difficult, laryngitis and pharyngitis
4. Anal condyloma lata
5. Enlarged spleen and liver
6. Paralysis of one limb
7. Jaundice
1.Anemia
2.Failure to gain weight
3.Marasmus
4.Gastroenteritis
5.Bone lesions
• Saddle nose (no bridge to nose)
Confirmation of diagnosis
•Spirochetes seen on dark field examination of lesions, body fluid, or
CSF.
•VDRL titres higher than maternal titres
•Rising VDRL titres over the following 6-12 weeks
•The infant’s treponemal antibody titre (FTA-ABS and/or MHA-TP)
remains positive at 12 to 18 months of age.
•FTA - absorption test is positive
Treatment of congenital syphilis
•If the mother has a positive serologic test for syphilis or is symptomatic
but the new born shows no signs of syphilis, whether or not the mother
was treated, give benzathine penicillin 50 000units /Kg body weight IM
as a single dose.
•If CSF is normal treat as above or give procaine penicillin 50 000 i.u.
daily for 10 days
•If CSF is abnormal: admit, then give crystalline penicillin 50 000 I.U
IM/IV 12 hourly for at least 10 days.