Recovering Fetuses from Syphilis: Antenatal Care, Maternal, and Neonatal Outcomes

Year 2021, Volume: 11 Issue: 2, 265 - 271, 29.06.2021

Deniz Şimşek

https://doi.org/10.31832/smj.801833

Abstract

Objective:
Syphilis is a disease as old as human history.Untreated syphilis during pregnancy can cause serious prenatal adverse outcomes, including stillbirth, and congenital syphilis. World Health Organization, obstetrics and gynecology societies recommends screening syphilis at the first antenatal care visit. In this present study, it was aimed to discuss antenatal follow-up, maternal and neonatal outcomes of patients having syphilis infection during pregnancy.
Material and Method:
Patients diagnosed with syphilis during pregnancy were included in the study. Patients were screened by a Non-Treponomal test and positive results were confirmed by the Treponemal test. Patients data including antenatal examinations, maternal and neonatal results, syphilis treatment, newborn examination findings, syphilis treatment follow-up were obtained and evaluated retrospectively through the hospital registry system and telephone interviews.
Results:
The total number of patients who were screened with RPR in the first antenatal visit of the pregnancy over two and a half years period was 24427. Ten patients were diagnosed with syphilis by Treponemal test (TP-PA) confirmation. All patients were treated by three doses of Penicillin Benzathine G 2.4 million units via intramuscular route each at a one-week interval. All women gave birth at term without complication. Forty percent of patients diagnosed gestational diabetes mellitus. No congenital syphilis occurred. None of the patients had concomitant HIV and HCV infection.
Conclusion:
Eradication is possible for syphilis. Early detection at the first antenatal visit and adequate treatment with penicillin would prevent maternal and congenital syphilis, and recover babies from adverse outcomes of syphilis.

Keywords

Non-treponemal test, Treponemal test, Syphilis, syphilis in pregnancy, Penicillin benzathine G

Supporting Institution

Yok

Project Number

Yok

Thanks

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Fetüslerin Sifilizden Zarar Görmemesi: Antenatal Bakım, Maternal ve Neonatal Sonuçlar

Abstract

Amaç: Sifiliz insanlık tarihi kadar eski bir hastalıktır. Gebelikte tedavi edilmeyen sifiliz, ölü doğum da dahil ciddi prenatal sonuçlara ve konjenital sifilize neden olabilir. Dünya Sağlık Örgütü, obstetrik ve jinekoloji dernekleri ilk antenatal muayenede sifilizin taranmasını önermektedir. Bu çalışmada, gebeliğinde sifiliz enfeksiyonu saptanan hastaların, antenatal takipleri, maternal ve neonatal sonuçlarının tartışılması amaçlanmıştır.
Gereç ve yöntemler:Gebelik sırasında sifiliz tanısı alan hastalar çalışmaya dahil edildi. Hastalar Non-Treponomal test(RPR) ile tarandı ve pozitif sonuçlar Treponemal test(TP-HA) ile doğrulandı. Antenatal bakılar, maternal ve neonatal sonuçlar, sifiliz tedavisi, yenidoğanın muayene bulguları, sifiliz tedavi takibini içeren hasta verileri retrospektif olarak hastane kayıt sistemi ve hasta telefon görüşmeleri ile elde edilerek değerlendirildi.
Bulgular:Yaklaşık 2.5 yıllık süreçte 24427 hasta gebeliğinin ilk antenatal muayenesinde sifiliz için RPR testi ile taranmıştır. On hastaya Treponemal test (TP-PA) ile doğrulanarak sifiliz tanısı koyulmuştur. Tüm hastalara,1 hafta aralıklarla 3 doz Penisilin Benzatin G 2.4 milyon ünite intramuskuler yolla tedavi uygulandı. Tüm kadınlar miadında, komplikasyonsuz olarak doğum yaptı. Hastaların yüzde 40'ı gestasyonel diyabetes mellitus tanısı aldı. Konjenital sifiliz olgusu saptanmadı. Hiçbir hastada eşlik eden HIV ve HCV enfeksiyonu saptanmadı.
Sonuç:Sifiliz için eradikasyon mümkündür. İlk antenatal kontrolde erken tarama ve penisilin ile yeterli tedavi, maternal ve konjenital sifilizi ortaya çıkmasını engelleyecek ve bebeklerin sifilizin etkilerinden kurtarılmasını sağlayacaktır.

Keywords

Sifiliz, gebelikte sifiliz, Non-treponemal test, Treponemal test, Penisilin benzatin G

Project Number

Yok

References

• 1. Qin J, Yang T, Xiao S, Tan H, Feng T, Fu H. Reported estimates of adverse pregnancy outcomes among women with and without syphilis: a systematic review and meta-analysis. PLoS One2014;9(7).
• 2. Prevention CfDCa. Sexually Transmitted Disease Surveillance 2017. 2018.
• 3. Schmid GP, Stoner BP, Hawkes S, Broutet N. The need and plan for global elimination of congenital syphilis. Sexually transmitted diseases2007;34(7):5-10.
• 4. Prevention ECfD, Control. Annual Epidemiological Report: ECDC, European Centre for Disease Prevention and Control2012.
• 5. Organization WH. WHO guideline on syphilis screening and treatment for pregnant women: World Health Organization2017.
• 6. Aktas G. Serological Diagnosis of Syphilis. Turk Mikrobiyol Cem Derg2005;35(1):6.
• 7. Alexander JM, Sheffield JS, Sanchez PJ, Mayfield J, Wendel GD, Jr. Efficacy of treatment for syphilis in pregnancy. Obstetrics and gynecology1999;93(1):5-8.
• 8. Republic of Turkey MoH. Syphilis statistics, The distribution of syphilis cases by year. 2020.
• 9. Durusoy R, Karababa AO. Completeness of hepatitis, brucellosis, syphilis, measles and HIV/AIDS surveillance in Izmir, Turkey. BMC Public Health2010;10(1):71.
• 10. Kahn JG, Jiwani A, Gomez GB, Hawkes SJ, Chesson HW, Broutet N, et al. The cost and cost-effectiveness of scaling up screening and treatment of syphilis in pregnancy: a model. PLoS One2014;9(1).
• 11. Bristow CC, Larson E, Anderson LJ, Klausner JD. Cost-effectiveness of HIV and syphilis antenatal screening: a modelling study. Sex Transm Infect2016;92(5):340-346.
• 12. Gomez GB, Kamb ML, Newman LM, Mark J, Broutet N, Hawkes SJ. Untreated maternal syphilis and adverse outcomes of pregnancy: a systematic review and meta-analysis. Bulletin of the World Health Organization2013;91:217-226.
• 13. Liu H, Chen N, Yu J, Tang W, He J, Xiao H, et al. Syphilis-attributable adverse pregnancy outcomes in China: a retrospective cohort analysis of 1187 pregnant women with different syphilis treatment. BMC infectious diseases2019;19(1):292.
• 14. Torres RG, Mendonça ALN, Montes GC, Manzan JJ, Ribeiro JU, Paschoini MC. Syphilis in pregnancy: the reality in a public hospital. Revista Brasileira de Ginecologia e Obstetrícia/RBGO Gynecology and Obstetrics2019;41(02):90-96.
• 15. De Santis M, De Luca C, Mappa I, Spagnuolo T, Licameli A, Straface G, et al. Syphilis infection during pregnancy: fetal risks and clinical management. Infectious diseases in obstetrics and gynecology 2012;4:(3):5-8
• 16. Vashisht D, Baveja S. Eponyms in syphilis. Indian journal of sexually transmitted diseases and AIDS2015;36(2):226.
• 17. Fiumara NJ. Syphilis in newborn children. Clinical obstetrics and gynecology1975;18(1):183-9.
• 18. Rac MW, Bryant SN, McIntire DD, Cantey JB, Twickler DM, Wendel Jr GD, et al. Progression of ultrasound findings of fetal syphilis after maternal treatment. American journal of obstetrics and gynecology2014;211(4):426.
• 19. Fuchs F, Michaux K, Rousseau C, Ovetchkine P, Audibert F. Syphilis infection: an uncommon etiology of infectious nonimmune fetal hydrops with anemia. Fetal diagnosis and therapy2016;39(1):74-7.
• 20. Wendel Jr GD, Sheffield JS, Hollier LM, Hill JB, Ramsey PS, Sánchez PJ. Treatment of syphilis in pregnancy and prevention of congenital syphilis. Clinical Infectious Diseases2002;35(2):200-209.
• 21. Alexander JM, Sheffield JS, Sanchez PJ, Mayfield J, Wendel Jr GD. Efficacy of treatment for syphilis in pregnancy. Obstetrics & Gynecology1999;93(1):5-8.
• 22. Workowski KA, Berman SM. CDC sexually transmitted diseases treatment guidelines. Clinical Infectious Diseases2002;35(2):135-137.
• 23. Workowski KA. Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines. Clinical Infectious Diseases2015;61(8):759-762.
• 24. Myles TD, Elam G, Park-Hwang E, Nguyen T. The Jarisch-Herxheimer reaction and fetal monitoring changes in pregnant women treated for syphilis. Obstetrics and gynecology1998;92(5):859-864.
• 25. Rac MW, Revell PA, Eppes CS. Syphilis during pregnancy: a preventable threat to maternal-fetal health. Am J Obstet Gynecol2017;216(4):352-363.
• 26. Yang T, Tong M, Xi Y, Guo X, Chen Y, Zhang Y, et al. Association between neurosyphilis and diabetes mellitus: Resurgence of an old problem Journal of diabetes2014;6(5):403-408.
• 27. Janier á, Hegyi V, Dupin N, Unemo M, Tiplica G, Potočnik M, et al. 2014 European guideline on the management of syphilis. Journal of the European Academy of Dermatology and Venereology2014;28(12):1581-1593.
• 28. Republic of Turkey MoH. Syphilis Surveillance In: Directorate PHG, editor. Infectious Diseases Department2020.