Congenital syphilis: types, causes, diagnosis and treatment

Congenital syphilis

Congenital syphilis is probably the most dangerous form of this disease. It affects the fetus during intrauterine development, resulting in the formation of severe, often lethal complications.

However, timely treatment, even during pregnancy often prevents transmission of bacteria from mother to child and to avoid the consequences.

How is the infection?

Congenital syphilis develops in two ways:

• The mother was already infected before conception, but not passed on time treatment and at the moment of conception has active syphilis.
• The infection occurred during pregnancy.

In the first case, it is important to know how long the mother is sick. The highest risk of transfer of bacteria to the fetus in the first 2-3 years of secondary syphilis. At later stages, including tertiary, infection becomes less active, and intrauterine infection often occurs. But when fresh syphilis the vast majority of pregnancies without treatment lead to infection of the fetus.

There is a theory that long-term course of syphilis in women leads to a change of eggs. Defective gametes can cause difficulties with conception and congenital abnormalities.

• With blood flow through the umbilical vein.
• With the flow of lymph through the lymphatic cracks.
• From an infected placenta.

This is relatively late transmission of pathogens due to the peculiarities of the formation of the placenta and blood flow from mother to child. Because of this, if the time to start the treatment of syphilis in pregnant women, it is possible to avoid infection of the fetus.

Statistics of congenital syphilis

It is important to understand that most pregnancies infected with syphilis mothers end intrauterine fetal death, late miscarriage or stillbirth. Heavy, often incompatible with life pathology without treatment almost always develops.

Adequate and prompt treatment increases the likelihood of the birth of a healthy child of up to 90%. Cases of stillbirths is about 6%, and congenital syphilis – 4%. If the treatment was not assigned or not completed, the likelihood of having a healthy child is reduced to 40%, development of fetal syphilis increases to 30%, stillbirths by 30%.

Today this problem is becoming more urgent due to the increase in the number of infected pregnant women and, therefore, cases of congenital syphilis.

The types of congenital syphilis

Today adopted a classification in which congenital syphilis in children are divided into categories, depending on what stage the symptoms:

• Early congenital syphilis. There are several subtypes: fetal, infant and young children. In these cases, the symptoms appear immediately after birth or in the first 2-3 years of life.
• Late congenital syphilis. In some cases, the disease manifests itself rather late – after 3-4 years.

Sometimes in a separate category allocate latent syphilis, which does not show any symptoms or changes, but in the body of the child present of Treponema pallidum.

Without treatment, these patients are dangerous to others – they can infect other people. Earlier, before the invention of effective methods of treatment, documented cases of transmission of congenital syphilis in the second and even the third generation.

Manifestations of early syphilis in newborns

First and foremost, it is important to understand that syphilis in children is manifested in a variety of pathologies and symptoms. This disease can cause physical, psychological and intellectual development.

So early congenital syphilis often causes a whole group of physiological changes and disturbances:

• The child's weight at birth is below normal, the head is large, face dry and wrinkled. The nose stuck. Often hypertrophiedfrontal bossing, a characteristic "buttock" form of the skull, often it is extended. The skin is flabby, pale, often there are pigmented areas. Limbs thin. Subcutaneous fat is almost absent.
• Behavior restless, newborns often disturbing sleep, because of disorders in the nervous system during sudden movements he screamed.
• Early congenital syphilis is often up to 70% of cases have symptoms on the skin in the first place – syphilitic pemphigus. Under this condition, the skin of newborn there are many small bubbles with a tight lid and serous content. If the damage bubbles in their place are sores that gradually dry up, forming crusts.
• Characteristic lesions of lungs, degeneration of alveoli and other tissues. Often a so-called "white pneumonia".
• Newborns develops persistent runny nose, causing difficulty breathing and the process of sucking.
• Many infants disturbed the structure of the teeth, they have a barrel-shaped or chisel-shaped form, the enamel is broken or missing.

If you do not start treatment immediately after birth, these children often die in the first days or months of life. But even then you can stay persistent damage and health disorders.

Late manifestations of syphilis of the newborn

Late congenital syphilis manifests itself differently. Characteristic physiological changes may be absent or but weakly expressed. At birth, these children may have abnormalities or disorders, but their body is present in Treponema pallidum.

In most cases, this form manifests itself as a relapse of secondary syphilis without acute manifestations. You may receive warts, rashes in the form of papules and pustules, in some cases, education Gumm.

In addition to the external manifestations, there may be changes in the internal organs, primarily glands of internal secretion, sweat glands. Often fix violations on the part of organs of vision and hearing.

Often late syphilis in children, causes disorders of the nervous system: developmental delay, speech disorders, seizures, type of epilepsy, paresis.

Diagnosis of congenital syphilis

Diagnosis of congenital syphilis includes several directions:

• Laboratory testing to determine the presence of pathogens and their number.
• A full examination to determine what pathology is caused the disease.

The survey can include a wide range of research: x-rays, ultrasound, biochemical examination and so on.

Laboratory diagnosis requires confirmation of the diagnosis and adequate treatment. It should be done for all children born from women not deregistered in kozhvendispansere in connection with a history of syphilis.

More effective methods associated with finding themselves of pathogens. They are in large numbers are contained in the umbilical cord, so immediately after delivery of her blood was taken for the study. Also sometimes the diagnosis sending part of the umbilical cord.

To confirm congenital syphilis, also determine the antibody titers at the same time the child and mother. The result is considered positive if the child they are higher than in the mother.

Prevention of congenital syphilis

Syphilis newborn with severe disease affecting all organs and systems. Of course, even if the mother did not receive treatment, there is some chance for a viable birth of a healthy baby, but seriously count on it is impossible, because the chance of stillbirth or developmental abnormalities is much higher.

Therefore, in all countries, including and Russia in all antenatal clinics of doctors very seriously the prevention of syphilis in newborns. There is a compulsory mass screening of all pregnant women, regardless of their condition and medical history. Syphilis is a complex disease, often women are unaware that they are infected and take the symptoms for some other condition. Therefore, even in the absence of external signs and subjective complaints, we cannot exclude this diagnosis.

The primary actions are taken at the stage of pregnancy planning. Preferably before conception for a complete examination, including tests for syphilis. In most cases it turns out to be negative, but even a small probability of a positive result, it is better to exclude.

In addition, women have several times in the course of pregnancy to be screened for syphilis. First time analysis when doing the registration, the second on the period of about 26-30 weeks, and the third before the birth.

If all three times she gets a negativethe result, then there is no danger neither for the mother nor for the baby.

Pregnant usually do a blood test for Wasserman. This method of diagnosis of syphilis has high sensitivity, but relatively often gives a false positive result. Therefore, if you receive a positive response, it is required to confirm other, more accurate methods.

Particular attention doctors treat women who consist on the account in kozhvendispansere after suffering syphilis. They need to pass additional tests to make sure that all the pathogens are completely destroyed, and the fetus does not appear congenital syphilis.

Of course, during pregnancy is particularly important individual prevention. Invalid unfamiliar sex partners, random sexual acts. Infection in this period represents an increased threat to both the mother and fetus.

The treatment of syphilis during pregnancy

To prevent syphilis in children is possible, but it is necessary to begin treatment in a timely manner. The peculiarity of this disease is that infection occurs not in the early stages, and in the second half after 20-24 weeks, when formed by the more active blood flow between mother and fetus, and bacteria affect the placenta.

For the treatment of pregnant woman infected with syphilis use penicillin. Treponema pallidum is highly sensitive to this antibiotic, and he has severe teratogenic properties and has no effect on pregnancy. Also, this drug is well penetrates through the placenta, and hence is able to destroy the pathogen not only in the mother's body, but also in the placenta and the body of the child.

The course is usually 20-25 days, during which the antibiotic is administered intravenously over short periods of time. Treatment is prescribed immediately after the diagnosis was confirmed. In addition, often carry out repeated, preventative rate at the period of 20-24 weeks.

Full quality treatment considerably, up to 90% increases the probability of healthy child birth!

Subsequently, the woman several times will need to be tested for syphilis, and the child after birth is automatically registered in the dermatovenerologic dispensary and must undergo a full examination. You may have to repeat it after some time to confirm the absence of congenital syphilis.

But observation for several years to produce clear results, and the child's lack of typical manifestations of congenital syphilis allow you to remove it from the register.

So even infected with syphilis, the mother can give birth to a healthy child, taking into account that during pregnancy it will be proper and complete treatment. Therefore it is impossible to neglect the examination and, if necessary, therapy.