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The prevention and management of congenital syphilis: an overview and recommendations
Saloojee,Haroon; Velaphi,Sithembiso; Goga,Yasmin; Afadapa,Nike; Steen,Richard; Lincetto,Ornella;
Bulletin of the World Health Organization , 2004, DOI: 10.1590/S0042-96862004000600007
Abstract: the continued occurrence of congenital syphilis is an indictment of the inadequate antenatal care services and poor quality of programmes to control sexually transmitted infections. more than 1 million infants are born with congenital syphilis each year. despite national policies on antenatal testing and the widespread use of antenatal services, syphilis screening is still implemented only sporadically in many countries, leaving the disease undetected and untreated among many pregnant women. the weak organization of services and the costs of screening are the principal obstacles facing programmes. decentralization of antenatal syphilis screening programmes, on-site testing and immediate treatment can reduce the number of cases of congenital syphilis. antenatal syphilis screening and treatment programmes are as cost effective as many existing public health programmes, e.g. measles immunization. diagnosis of congenital syphilis is problematic since more than half of all infants are asymptomatic, and signs in symptomatic infants may be subtle and nonspecific. newer diagnostic tests such as enzyme immunoassays, polymerase chain reaction and immunoblotting have made diagnosis more sensitive and specific but are largely unavailable in the settings where they are most needed. guidelines developed for better-resourced settings are conservative and err on the side of overtreatment. they are difficult to implement in, or inappropriate for, poorly-resourced settings because of the lack of investigative ability and the pressure on health facilities to discharge infants early. this paper offers recommendations for treating infants, including an approach based solely on maternal serological status and clinical signs of syphilis in the infant.
The prevention and management of congenital syphilis: an overview and recommendations  [cached]
Saloojee Haroon,Velaphi Sithembiso,Goga Yasmin,Afadapa Nike
Bulletin of the World Health Organization , 2004,
Abstract: The continued occurrence of congenital syphilis is an indictment of the inadequate antenatal care services and poor quality of programmes to control sexually transmitted infections. More than 1 million infants are born with congenital syphilis each year. Despite national policies on antenatal testing and the widespread use of antenatal services, syphilis screening is still implemented only sporadically in many countries, leaving the disease undetected and untreated among many pregnant women. The weak organization of services and the costs of screening are the principal obstacles facing programmes. Decentralization of antenatal syphilis screening programmes, on-site testing and immediate treatment can reduce the number of cases of congenital syphilis. Antenatal syphilis screening and treatment programmes are as cost effective as many existing public health programmes, e.g. measles immunization. Diagnosis of congenital syphilis is problematic since more than half of all infants are asymptomatic, and signs in symptomatic infants may be subtle and nonspecific. Newer diagnostic tests such as enzyme immunoassays, polymerase chain reaction and immunoblotting have made diagnosis more sensitive and specific but are largely unavailable in the settings where they are most needed. Guidelines developed for better-resourced settings are conservative and err on the side of overtreatment. They are difficult to implement in, or inappropriate for, poorly-resourced settings because of the lack of investigative ability and the pressure on health facilities to discharge infants early. This paper offers recommendations for treating infants, including an approach based solely on maternal serological status and clinical signs of syphilis in the infant.
Missed opportunities for congenital syphilis and HIV perinatal transmission prevention
Rodrigues,Celeste Souza; Guimar?es,Mark Drew Crosland; César,Cibele Comini;
Revista de Saúde Pública , 2008, DOI: 10.1590/S0034-89102008000500010
Abstract: objective: to estimate the prevalence of missed opportunities for congenital syphilis and hiv prevention in pregnant women who had access to prenatal care and to assess factors associated to non-testing of these infections. methods: cross-sectional study comprising a randomly selected sample of 2,145 puerperal women who were admitted in maternity hospitals for delivery or curettage and had attended at least one prenatal care visit, in brazil between 1999 and 2000. no syphilis and/or anti-hiv testing during pregnancy was a marker for missed prevention opportunity. women who were not tested for either or both were compared to those who had at least one syphilis and one anti-hiv testing performed during pregnancy (reference category). the prevalence of missed prevention opportunity was estimated for each category with 95% confidence intervals. factors independently associated with missed prevention opportunity were assessed through multinomial logistic regression. results: the prevalence of missed prevention opportunity for syphilis or anti-hiv was 41.2% and 56.0%, respectively. the multivariate analysis showed that race/skin color (non-white), schooling (<8 years), marital status (single), income (<3 monthly minimum wages), having sex during pregnancy, history of syphilis prior to the current pregnancy, number of prenatal care visits (<6), and last prenatal visit before the third trimester of gestation were associated with an increased risk of missed prevention opportunity. a negative association with missed prevention opportunity was found between marital status (single), prenatal care site (hospital) and first prenatal visit in the third trimester of gestation. conclusions: high rates of non-tested women indicate failures in preventive and control actions for hiv infection and congenital syphilis. pregnant women have been discontinuing prenatal care at an early stage and are failing to undergo prenatal screening for hiv and syphilis.
Is Congenital Syphilis Really Congenital Syphilis?  [PDF]
Yi Li,Bernard Gonik
Infectious Diseases in Obstetrics and Gynecology , 2006, DOI: 10.1155/idog/2006/81629
Abstract: Detroit has recently been distinguished as having the highest congenital syphilis rate in the United States (250.3 cases per 100 000 live births in Detroit versus 10.3 in the US). However, depending on each health department's followup and CDC reporting, these data may not accurately reflect the true congenital syphilis rate. This study examines the reported cases over a three-year time period with focus on the criteria used for diagnosis. All local health department congenital syphilis CDC collection forms (form 73.126) were reviewed for the years in question. The reported congenital syphilis cases in the year 2002–2004 in Detroit were reviewed. No cases met confirmed case criteria and few probable cases were based on neonatal evaluations. The majority of “congenital syphilis” cases were established based on incomplete maternal data such as missing followup serologic titers in the absence of complete neonatal information. In conclusion, although the reported congenital syphilis rate in Detroit is alarmingly high, the true occurrence of congenital syphilis is likely to have been overstated. A health department reporting program that includes more diligent neonatal followup would allow for a more accurate representation of this public health concern.
Late congenital syphilis with stigmata  [cached]
Modi Megha,Sharma Archana,Marfatia Yogesh,Naik Eknath
Indian Journal of Sexually Transmitted Diseases , 2008,
Abstract: Congenital syphilis is a rare entity and is an indicator of sexually transmitted diseases in a given population. We are reporting a case of late congenital syphilis presenting with palatal perforation at an age of 13 years.
Symptomatic Early Congenital Syphilis: A Common but Forgotten Disease
Machiraju Vasudeva Murali,Cherukuri Nirmala,Jampana Venkateswara Rao
Case Reports in Pediatrics , 2012, DOI: 10.1155/2012/934634
Abstract: Congenital syphilis is a severe, disabling infection often with grave consequences seen in infants. It occurs due to the transmission of the disease from an infected mother to the unborn infant through the placenta. This long forgotten disease continues to affect pregnant women resulting in perinatal morbidity and mortality. The continuing prevalence of this disease reveals the failure of control measures established for its prevention. We put forth a case of symptomatic congenital syphilis presenting with skeletal manifestations at birth, a rare finding in literature. The report stresses upon the importance of implementing the World Health Organization's recommendation that all pregnant women should be screened for syphilis in the first antenatal visit in the first trimester and again in the late pregnancy.
Maternal and congenital syphilis in Bolivia, 1996: prevalence and risk factors
Southwick,Karen L.; Blanco,Stanley; Santander,Ana; Estenssoro,Miguel; Torrico,Faustino; Seoane,Guillermo; Brady,William; Fears,Martha; Lewis,Joel; Pope,Victoria; Guarner,Jeannette; Levine,William C.;
Bulletin of the World Health Organization , 2001, DOI: 10.1590/S0042-96862001000100008
Abstract: objectives: the present study was carried out in seven maternity hospitals to determine the prevalence of maternal syphilis at the time of delivery and the associated risk factors, to conduct a pilot project of rapid syphilis testing in hospital laboratories, to assure the quality of syphilis testing, and to determine the rate of congenital syphilis in infants born to women with syphilis at the time of delivery - all of which would provide baseline data for a national prevention programme in bolivia. methods: all women delivering either live-born or stillborn infants in the seven participating hospitals in and around la paz, el alto, and cochabamba between june and november 1996 were eligible for enrolment in the study. findings: a total of 61 out of 1428 mothers (4.3%) of live-born infants and 11 out of 43 mothers (26%) of stillborn infants were found to have syphilis at delivery. multivariate analysis showed that women with live-born infants who had less than secondary-level education, who did not watch television during the week before delivery (this was used as an indicator of socioeconomic status), who had a previous history of syphilis, or who had more than one partner during the pregnancy were at increased risk of syphilis. while 76% of the study population had received prenatal care, only 17% had syphilis testing carried out during the pregnancy; 91% of serum samples that were reactive to rapid plasma reagin (rpr) tests were also reactive to fluorescent treponemal antibody-absorption (fta-abs) testing. there was 96% agreement between the results from local hospital laboratories and national reference laboratories in their testing of rpr reactivity of serum samples. congenital syphilis infection was confirmed by laboratory tests in 15% of 66 infants born to women with positive rpr and fta-abs testing. conclusion: these results indicate that a congenital syphilis prevention programme in bolivia could substantially reduce adverse infant outcomes due to this dis
Maternal and congenital syphilis in Bolivia, 1996: prevalence and risk factors  [cached]
Southwick Karen L.,Blanco Stanley,Santander Ana,Estenssoro Miguel
Bulletin of the World Health Organization , 2001,
Abstract: OBJECTIVES: The present study was carried out in seven maternity hospitals to determine the prevalence of maternal syphilis at the time of delivery and the associated risk factors, to conduct a pilot project of rapid syphilis testing in hospital laboratories, to assure the quality of syphilis testing, and to determine the rate of congenital syphilis in infants born to women with syphilis at the time of delivery - all of which would provide baseline data for a national prevention programme in Bolivia. METHODS: All women delivering either live-born or stillborn infants in the seven participating hospitals in and around La Paz, El Alto, and Cochabamba between June and November 1996 were eligible for enrolment in the study. FINDINGS: A total of 61 out of 1428 mothers (4.3%) of live-born infants and 11 out of 43 mothers (26%) of stillborn infants were found to have syphilis at delivery. Multivariate analysis showed that women with live-born infants who had less than secondary-level education, who did not watch television during the week before delivery (this was used as an indicator of socioeconomic status), who had a previous history of syphilis, or who had more than one partner during the pregnancy were at increased risk of syphilis. While 76% of the study population had received prenatal care, only 17% had syphilis testing carried out during the pregnancy; 91% of serum samples that were reactive to rapid plasma reagin (RPR) tests were also reactive to fluorescent treponemal antibody-absorption (FTA-ABS) testing. There was 96% agreement between the results from local hospital laboratories and national reference laboratories in their testing of RPR reactivity of serum samples. Congenital syphilis infection was confirmed by laboratory tests in 15% of 66 infants born to women with positive RPR and FTA-ABS testing. CONCLUSION: These results indicate that a congenital syphilis prevention programme in Bolivia could substantially reduce adverse infant outcomes due to this disease.
Symptomatic Early Congenital Syphilis: A Common but Forgotten Disease  [PDF]
Machiraju Vasudeva Murali,Cherukuri Nirmala,Jampana Venkateswara Rao
Case Reports in Pediatrics , 2012, DOI: 10.1155/2012/934634
Abstract: Congenital syphilis is a severe, disabling infection often with grave consequences seen in infants. It occurs due to the transmission of the disease from an infected mother to the unborn infant through the placenta. This long forgotten disease continues to affect pregnant women resulting in perinatal morbidity and mortality. The continuing prevalence of this disease reveals the failure of control measures established for its prevention. We put forth a case of symptomatic congenital syphilis presenting with skeletal manifestations at birth, a rare finding in literature. The report stresses upon the importance of implementing the World Health Organization's recommendation that all pregnant women should be screened for syphilis in the first antenatal visit in the first trimester and again in the late pregnancy. 1. Introduction Congenital syphilis is a severe, disabling infection often with grave consequences seen in infants. Syphilis continues to affect pregnant population, in spite of numerous control measures in place established for its prevention. Worldwide, World Health Organization (WHO) estimates that two million pregnant women get infected with syphilis, every year [1]. Without adequate treatment many of them transmit this infection to their offspring, thus increasing the number of reported cases of stillborn, preterm, low birth weight, or congenital infection. Congenital syphilis results from transplacental transmission of spirochetes. Approximately 66% of infected infants from congenital syphilis are asymptomatic at the time of birth and are identified only by routine prenatal screening. Untreated syphilis during pregnancy has a transmission rate nearing 100%. Fetal or perinatal death occurs in 40% of affected infants [2]. Clinical signs appear in approximately two-thirds of affected infants from 3rd to 8th week of life and in most cases by three months of age [3]. Primary skeletal involvement is rare [4]. We are reporting one such case of symptomatic congenital syphilis that presented with skeletal manifestations soon after birth, a rare finding in literature [5]. 2. Case Presentation A 6 days old full-term, female infant presented with complaints of restricted movements of upper extremities. The infant was born at home through vaginal route and was third in birth order. The infant cried at birth and was exclusively breastfed. On the third day of life, the mother noticed swelling of both the elbow joints. There was no history of trauma, bleeding from any site, bruising, fever, seizures, or altered sensorium. On examination the infant weighed
Prevention of congenital syphilis: time for action  [cached]
Walker Damian G.,Walker Godfrey J. A.
Bulletin of the World Health Organization , 2004,
Abstract:
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