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1.  Syphilis intervention in pregnancy: Zambian demonstration project. 
Genitourinary Medicine  1990;66(3):159-164.
Despite availability of simpler serologic tests for syphilis and near cure with penicillin, unacceptably high prevalence of infectious maternal syphilis exist in many developing countries, including Zambia. It is the foremost risk factor for mid-trimester abortions, stillbirths, prematurity and morbidity and mortality among infants born with congenital syphilis in Zambia. An intervention project was conducted in Lusaka aimed at demonstrating the effectiveness of new health education methods and prenatal screening for syphilis in reducing the adverse outcomes during pregnancy. During pre-intervention phase, approximately 150 consecutive pregnant women from each of the three study and the three control centres were recruited when they presented in labour at the University Teaching Hospital. The intervention phase lasted for one year at the three study centres during which new methods of health education were introduced to improve early attendances during pregnancy. Also, on-site syphilis screening was performed twice during pregnancy and seroreactive women, and in many cases their sexual partners, were treated by the existing prenatal clinic staff. During the post-intervention phase the steps of pre-intervention phase were repeated to evaluate the impact of intervention. Overall, 8.0% of women were confirmed seroreactive for syphilis; there was no difference between the study and the control centres (p greater than 0.05). Fifty seven percent (132/230) of syphilitic pregnancies ended with an adverse outcome, that is, abortion (RR 5.0), stillbirth (RR 3.6), prematurity (RR 2.6) and low birth weight (RR 7.8). The overall risk of adverse outcomes due to syphilis was 8.29 (95% confidence interval 6.53, 10.53). The new methods of health education were effective and the percentage of women who had their first prenatal visit under 16 weeks of gestation improved from 9.4 to 42.5. Although screening and treatment during intervention was suboptimal, the adverse outcomes attributable to syphilis were reduced to 28.3%; this is almost a two-third reduction when compared with 72.4% of adverse outcomes at control centres (p < less than 0.001). The intervention is culturally and politically acceptable in Zambia. The cost of each prenatal screening is US$0.60 and of averting each adverse outcome US$12. In countries with high rates of syphilis, there is an urgent need for STD control and Maternal and Child Health (MCH) programmes to pool their resources together to revitalise the prenatal care.
PMCID: PMC1194495  PMID: 2370060
2.  Congenital syphilis in the Russian Federation: magnitude, determinants, and consequences 
Sexually Transmitted Infections  2003;79(2):106-110.
Objectives: Reported cases of congenital syphilis in the Russian Federation increased 26-fold from 1991–9. Our objectives were to describe the frequency, risk factors, and consequences of delivering an infant with congenital syphilis among pregnant women with active syphilis.
Methods: In a retrospective record review using consecutive sampling of logs at maternity hospitals in five geographic areas, data were abstracted for 850 women with active syphilis during pregnancy who had completed ≥20 weeks' gestation. Further information was abstracted from records in antenatal clinics, dermatovenereology clinics, and paediatric hospitals. We assessed the frequency of confirmed or probable congenital syphilis, used logistic modelling to identify independent predictors for delivering a baby with congenital syphilis, and calculated the proportion of infants with congenital syphilis who experienced late fetal death (20–27 weeks), stillbirth (≥28 weeks), or infant death.
Results: A total of 64% (n=544) of 850 pregnant syphilis infected women delivered an infant with confirmed or probable congenital syphilis; 40% of the sample had no prenatal care. Among women with no prenatal care, 77% received either no treatment or inadequate treatment and 86% delivered an infant with congenital syphilis. Important independent and modifiable risk factors for delivery of an infant with congenital syphilis included receiving no prenatal care (adjusted OR 2.8, 95% CI 1.7 to 4.7) and having the first test for syphilis at ≥28 weeks' gestation (adjusted OR 4.0, 95% CI 2.6 to 6.0). Fatal outcomes were observed in 26% of infants with congenital syphilis, including late fetal death (7%), stillbirth (16%), or neonatal death (3%).
Conclusions: In the Russian Federation, the frequency of congenital syphilis is high, risk factors for congenital syphilis are modifiable, and the consequences of congenital syphilis are severe.
doi:10.1136/sti.79.2.106
PMCID: PMC1744638  PMID: 12690129
3.  Syphilis in pregnancy 
Syphilis can seriously complicate pregnancy and result in spontaneous abortion, stillbirth, non-immune hydrops, intrauterine growth restriction, and perinatal death, as well as serious sequelae in liveborn infected children. While appropriate treatment of pregnant women often prevents such complications, the major deterrent has been inability to identify the infected women and get them to undergo treatment. Screening in the first trimester with non-treponemal tests such as rapid plasma reagin (RPR) or venereal disease research laboratory (VDRL) test combined with confirmation of reactive individuals with treponemal tests such as the fluorescent treponemal antibody absorption (FTA-ABS) assay is a cost effective strategy. Those at risk should be retested in the third trimester. Treatment during pregnancy should be with penicillin. In determining a penicillin regimen, the clinician must consider the stage of the maternal infection and the HIV status of the mother. Patients who are allergic to penicillin should be desensitised before treatment. Despite appropriate treatment, as many as 14% will have a fetal death or deliver infected infants. Treatment may further be complicated by the Jarich–Herxheimer reaction, a complex allergic response to antigens released from dead micro-organisms, which can cause fetal distress and uterine contractions. Thanks to effective intervention strategies and inexpensive penicillin, syphilis rarely complicates pregnancy in the Western world today. In parts of the world where the traditional sexually transmitted diseases have not been controlled, the magnitude of problems associated with syphilis during pregnancy is reminiscent of that faced by the West during the early 1900s.
Key Words: syphilis; pregnancy
doi:10.1136/sti.76.2.73
PMCID: PMC1758294  PMID: 10858706
4.  Serological screening tests for syphilis in pregnancy: results of a five year study (1983-87) in the Oxford region. 
Journal of Clinical Pathology  1989;42(12):1281-1284.
Between 1983 and 1987, 62 out of 76519 pregnancies in 51 mothers had a positive miniaturised Treponema pallidum haemagglutination assay (TPHA) test--1 in 1234, or 0.81 per 1000 births. About two thirds of these mothers had syphilis and the remainder non-venereal treponematoses such as yaws or pinta. Antenatal screening identified 13 patients with previously unknown acquired syphilis, 11 of whom were given antibiotics during pregnancy. There were six fetal losses among the 62 TPHA positive pregnancies, but none had evidence of congenital syphilis. No live born child in this study group showed stigmata of congenital syphilis. It is concluded that despite the current low incidence of syphilis in the United Kingdom it is imperative to continue antenatal serological screening and to emphasise the importance of early adequate treatment of the infection.
PMCID: PMC502058  PMID: 2515214
5.  Early congenital syphilis still occurs. 
Archives of Disease in Childhood  1985;60(12):1128-1133.
Seven cases of early congenital syphilis have been recorded in the past 10 years in the Mersey Regional Health Authority. Antenatal serology was initially negative in five mothers, who were either incubating or acquired the infection later, and treatment had probably failed in two women given erythromycin for syphilis during pregnancy. Serology should be repeated later in pregnancy in those at high risk. Social factors that define this group include women who book for antenatal care late in pregnancy, have a past history of sexually transmitted disease, and have multiple consorts. Clinical signs in the infant such as failure to thrive, hepatosplenomegaly, symmetrical rash, rhinitis, and osteochondritis should alert the clinician to the possibility of congenital syphilis. Adequate management of mother and baby requires close liaison between the genitourinary physician, microbiologist, obstetrician, and paediatrician. Penicillin remains the treatment of choice.
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PMCID: PMC1777673  PMID: 3841473
6.  A Road Map for the Global Elimination of Congenital Syphilis 
Congenital syphilis is the oldest recognized congenital infection, and continues to account for extensive global perinatal morbidity and mortality today. Serious adverse pregnancy outcomes caused by maternal syphilis infection are prevented with screening early in pregnancy and prompt treatment of women testing positive. Intramuscular penicillin, an inexpensive antibiotic on the essential medicine list of nations all over the world, effectively cures infection and prevents congenital syphilis. In fact, at a cost of $11–15 per disability adjusted life year (DALY) averted, maternal syphilis screening and treatment is among the most cost-effective public health interventions in existence. Yet implementation of this basic public health intervention is sporadic in countries with highest congenital syphilis burden. We discuss the global burden of this devastating disease, current progress and ongoing challenges for its elimination in countries with highest prevalence, and next steps in ensuring a world free of preventable perinatal deaths caused by syphilis.
doi:10.1155/2010/312798
PMCID: PMC2913802  PMID: 20706693
7.  Syphilis in pregnant women in Zambia. 
Because of the high incidence of congenital syphilis at the University Teaching Hospital, Lusaka, Zambia, the potential risks of congenital infection and fetal loss due to syphilis were assessed by screening 202 antenatal patients, 340 pregnant women admitted to the hospital whose pregnancies ended in either spontaneous abortion or stillbirth, and 469 consecutive babies delivered at the hospital. Primary serological screening was performed with the rapid plasma reagin test, and reactive sera were confirmed by the Treponema pallidum haemagglutination test. In all cases detailed histories were obtained and patients were examined for clinical signs of syphilis. The TPHA test result was reactive in 12.5% of antenatal patients and in 42% of women who aborted in the later half of pregnancy. Among 469 consecutive babies delivered at the hospital, 30 had reactive results to the TPHA test; of these two were stillborn and four had signs of congenital syphilis at birth. Thus, syphilis appears to affect adversely an appreciably high number of pregnant women in Zambia. For this reason a special campaign to screen adequately and treat pregnant women and neonates is needed.
PMCID: PMC1046100  PMID: 6756542
8.  Congenital syphilis after treatment of maternal syphilis with a penicillin regimen exceeding CDC guidelines. 
BACKGROUND: Although congenital syphilis usually occurs as a result of a failure to detect and treat syphilis in pregnant women, failures of the currently recommended regimen to prevent congenital syphilis have been reported. CASE: This report describes an infant with congenital syphilis despite maternal treatment with a regimen exceeding current CDC guidelines. CONCLUSION: Regardless of the regimen used to treat syphilis during pregnancy, clinicians should recognize the possibility of occasional treatment failures and the importance of adequate follow-up of infants at risk for congenital syphilis.
doi:10.1002/(SICI)1098-0997(1998)6:3<134::AID-IDOG7>3.0.CO;2-X
PMCID: PMC1784788  PMID: 9785110
9.  Congenital syphilis in The Netherlands: cause and parental characteristics. 
Genitourinary Medicine  1988;64(5):298-302.
During 1982-5 the 19S (IgM) fluorescent treponemal antibody absorption (19S (IgM) FTA-ABS) test gave positive results in 19 children. The parental histories were analysed. As five of the children were adopted, 14 pregnancies were evaluated. Mothers of foreign origin and extramarital pregnancies were found to be over-represented. Of 13 women who attended for pregnancy checkup, three were not serologically screened for syphilis. In four the infection had developed late in the course of pregnancy. In at least four treatment had not been given or had been inadequate or too late. At least two had positive 19S (IgM) FTA-ABS test results that did not indicate congenital syphilis. The possibility of false positive 19S (IgM) FTA-ABS test results is pointed out. As the male sexual partners of four of the 14 mothers had presented elsewhere with early syphilis at the time of their partner's pregnancy, adequate contact tracing appears to be important to prevent congenital syphilis in future.
PMCID: PMC1194247  PMID: 3203930
10.  Syphilis in adults 
Sexually Transmitted Infections  2005;81(6):448-452.
Syphilis is a sexually transmitted disease with protean manifestations resulting from infection by Treponema pallidum. It is systemic early from the outset, the primary pathology being vasculitis. Acquired syphilis can be divided into primary, secondary, latent, and tertiary stages. The infection can also be transmitted vertically resulting in congenital syphilis, and occasionally by blood transfusion and non-sexual contact. Diagnosis is mainly by dark field microscopy in early syphilis and by serological tests. The management in the tropics depends on the diagnostic facilities available: in resource poor countries, primary syphilis is managed syndromically as for anogenital ulcer. The introduction of rapid "desktop" serological tests may simplify and promote widespread screening for syphilis. The mainstay of treatment is with long acting penicillin. Syphilis promotes the transmission of HIV and both infections can simulate and interact with each other. Treponemes may persist despite effective treatment and may have a role in reactivation in immunosuppressed patients. Partner notification, health education, and screening in high risk populations and pregnant women to prevent congenital syphilis are essential aspects in controlling the infection.
doi:10.1136/sti.2005.015875
PMCID: PMC1745064  PMID: 16326843
11.  Congenital Syphilis in Newborn 
California Medicine  1973;118(4):5-10.
In six cases of congenital syphilis in newborn at Los Angeles County-USC Medical Center over a seven-month period the clinical findings fell into two categories related to the time of onset of symptoms. Infants ill in the nursery presented evidence of transplacental infection; infants who became ill later showed the “classic” findings of rash, rhinorrhea and pseudoparalysis.
No single clinical symptom was present in all cases but all symptomatic infants had radiographic evidence of bone disease. Respiratory distress was present at the onset of symptoms in three of four infants with neonatal disease, and all three had evidence of interstitial pneumonia in chest radiographs.
Serologic testing may be difficult to evaluate in the newborn period, but more recent and specific tests are helpful in diagnosis. Penicillin remains the drug of choice. The only death occurred at five hours of life in a premature infant. Growth and development in surviving infants appeared normal.
PMCID: PMC1455023  PMID: 4692180
12.  Lives Saved Tool supplement detection and treatment of syphilis in pregnancy to reduce syphilis related stillbirths and neonatal mortality 
BMC Public Health  2011;11(Suppl 3):S9.
Background
Globally syphilis is an important yet preventable cause of stillbirth, neonatal mortality and morbidity.
Objectives
This review sought to estimate the effect of detection and treatment of active syphilis in pregnancy with at least 2.4MU benzathine penicillin (or equivalent) on syphilis-related stillbirths and neonatal mortality.
Methods
We conducted a systematic literature review of multiple databases to identify relevant studies. Data were abstracted into standardised tables and the quality of evidence was assessed using adapted GRADE criteria. Where appropriate, meta-analyses were undertaken.
Results
Moderate quality evidence (3 studies) supports a reduction in the incidence of clinical congenital syphilis of 97% (95% c.i 93 – 98%) with detection and treatment of women with active syphilis in pregnancy with at least 2.4MU penicillin. The results of meta-analyses suggest that treatment with penicillin is associated with an 82% reduction in stillbirth (95% c.i. 67 – 90%) (8 studies), a 64% reduction in preterm delivery (95% c.i. 53 – 73%) (7 studies) and an 80% reduction in neonatal deaths (95% c.i. 68 – 87%) (5 studies). Although these effect estimates were large and remarkably consistent across studies, few of the studies adjusted for potential confounding factors and thus the overall quality of the evidence was considered low. However, given these large observed effects and a clear biological mechanism for effectiveness the GRADE recommendation is strong.
Conclusion
Detection and appropriate, timely penicillin treatment is a highly effective intervention to reduce adverse syphilis-related pregnancy outcomes. More research is required to identify the most cost-effective strategies for achieving maximum coverage of screening for all pregnant women, and access to treatment if required.
doi:10.1186/1471-2458-11-S3-S9
PMCID: PMC3231915  PMID: 21501460
13.  CONGENITAL SYPHILIS IN CALIFORNIA 
California Medicine  1953;78(4):293-298.
Routine serologic tests for syphilis (as required by California law governing prenatal examination) and penicillin therapy during pregnancy for infected mothers have been major factors in the prevention of congenital syphilis in California during the past ten years. In 1940 one of each 822 infants had the disease, as indicated by morbidity reports of congenital syphilis in infants under the age of one year. In 1950 the ratio was one in 8,148. To determine why congenital syphilis continues to occur, a study of the 134 cases reported over a two-year period was made with the cooperation of local health officers and practicing physicians. It showed that in 76 per cent of cases the mother did not consult a physician prior to delivery or reported so late in pregnancy that the infant was born before adequate penicillin therapy could be given. In another 15 per cent syphilis developed in the mother during pregnancy after a negative reaction to a prenatal serologic test. The other 9 per cent of cases were due to various factors, such as infectious relapse or reinfection in previously adequately treated mothers. The study indicated that most cases occur in the lower socioeconomic population groups. Seventy-four per cent of cases were in infants delivered in county hospitals.
PMCID: PMC1521826  PMID: 13042663
14.  Antenatal Syphilis Screening Using Point-of-Care Testing in Sub-Saharan African Countries: A Cost-Effectiveness Analysis 
PLoS Medicine  2013;10(11):e1001545.
Yukari Manabe and colleagues evaluate the cost-effectiveness and budget impact of antenatal syphilis screening for 43 countries in sub-Saharan Africa and estimate the impact of universal screening on averted stillbirths, neonatal deaths, congenital syphilis, and DALYs.
Please see later in the article for the Editors' Summary
Background
Untreated syphilis in pregnancy is associated with adverse clinical outcomes for the infant. Most syphilis infections occur in sub-Saharan Africa (SSA), where coverage of antenatal screening for syphilis is inadequate. Recently introduced point-of-care syphilis tests have high accuracy and demonstrate potential to increase coverage of antenatal screening. However, country-specific cost-effectiveness data for these tests are limited. The objective of this analysis was to evaluate the cost-effectiveness and budget impact of antenatal syphilis screening for 43 countries in SSA and estimate the impact of universal screening on stillbirths, neonatal deaths, congenital syphilis, and disability-adjusted life years (DALYs) averted.
Methods and Findings
The decision analytic model reflected the perspective of the national health care system and was based on the sensitivity (86%) and specificity (99%) reported for the immunochromatographic strip (ICS) test. Clinical outcomes of infants born to syphilis-infected mothers on the end points of stillbirth, neonatal death, and congenital syphilis were obtained from published sources. Treatment was assumed to consist of three injections of benzathine penicillin. Country-specific inputs included the antenatal prevalence of syphilis, annual number of live births, proportion of women with at least one antenatal care visit, per capita gross national income, and estimated hourly nurse wages. In all 43 sub-Saharan African countries analyzed, syphilis screening is highly cost-effective, with an average cost/DALY averted of US$11 (range: US$2–US$48). Screening remains highly cost-effective even if the average prevalence falls from the current rate of 3.1% (range: 0.6%–14.0%) to 0.038% (range: 0.002%–0.113%). Universal antenatal screening of pregnant women in clinics may reduce the annual number of stillbirths by up to 64,000, neonatal deaths by up to 25,000, and annual incidence of congenital syphilis by up to 32,000, and avert up to 2.6 million DALYs at an estimated annual direct medical cost of US$20.8 million.
Conclusions
Use of ICS tests for antenatal syphilis screening is highly cost-effective in SSA. Substantial reduction in DALYs can be achieved at a relatively modest budget impact. In SSA, antenatal programs should expand access to syphilis screening using the ICS test.
Please see later in the article for the Editors' Summary
Editors' Summary
Background
Syphilis is a sexually transmitted infection caused by a bacterium called Treponema pallidum. In many countries, the screening and treatment program for syphilis in pregnancy is inadequate, leading to babies being affected. It is estimated that between 2.5% and 17% of pregnant women in sub-Saharan Africa are infected with syphilis; recent estimates suggest that more than 535,000 pregnancies occur in women with active syphilis each year. Maternal syphilis in pregnancy has been estimated to cause approximately half a million adverse outcomes in babies, including stillbirths, neonatal deaths, preterm or low-birth-weight babies, and congenital infections. If a pregnant woman is tested, and given penicillin if positive, then many of these harmful outcomes can be avoided. The best time to screen and treat is in the first half of pregnancy.
Until recently, tests for syphilis were done in a laboratory as an enzyme immunoassay, requiring technical staff. Recently, rapid tests for syphilis became available for use at the point of care. There are considerable advantages to this approach: the tests can be undertaken using a finger prick to obtain a small amount of blood, and require minimal staff training and no specialist laboratory equipment. A result can be given within minutes, avoiding the need for a return visit in settings where antenatal care is infrequent.
Why Was This Study Done?
Although the advantages to the mother and baby of testing seem clear, the cost-effectiveness of a screening and treatment program using rapid point-of-care tests has not previously been assessed for most sub-Saharan African countries. The program has the greatest potential value in settings where syphilis is common. In local guidelines, testing is often recommended, but uncertainty over the costs and technical requirements has meant that antenatal syphilis screening has not been comprehensively introduced. The aim of this study was to assess whether antenatal syphilis screening was cost-effective for 43 countries in sub-Saharan Africa by estimating the extent of infant mortality and disability that could be prevented if maternal syphilis was diagnosed and treated.
What Did the Researchers Do and Find?
The researchers created a model that allowed them to determine the cost-effectiveness of antenatal syphilis screening and treatment. They included many factors including the performance of the test, how common syphilis is in each country, the number of births, the likelihood of harmful outcomes, the effectiveness of penicillin therapy, the cost of an antenatal visit, and the cost of the test and the penicillin treatment, if positive. Then they calculated how many deaths and how much disability could be prevented by screening and treatment. The results were expressed in disability-adjusted life years (DALYs), which give the number of years affected by ill health, disability, or early death. The study found that screening was highly cost-effective, with each DALY prevented on average costing only US$11.
What Do These Findings Mean?
Across sub-Saharan Africa, only about 40% of women are screened for syphilis during one of their antenatal care visits. These findings suggest that it would be an efficient use of health care resources to scale up antenatal screening programs for syphilis using the rapid point-of-care test. Comparing these results to those for other health care interventions in resource-limited settings suggests that screening pregnant women for syphilis in sub-Saharan Africa could achieve a substantial improvement in public health at relatively little cost. The researchers propose that combining HIV and syphilis tests into one antenatal screening package could be an efficient way of introducing a care package into settings where uptake is currently limited.
Additional Information
Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001545.
The World Health Organization provides information on syphilis in pregnant women
The London School of Hygiene & Tropical Medicine has information on efforts to reduce congenital syphilis and a rapid syphilis test toolkit
The US Centers for Disease Control and Prevention's STD Curriculum includes materials on syphilis
doi:10.1371/journal.pmed.1001545
PMCID: PMC3818163  PMID: 24223524
15.  Congenital syphilis in newborn rabbits: immune functions and susceptibility to challenge infection at 2 and 5 weeks of age. 
Infection and Immunity  1991;59(5):1869-1871.
Experiments were performed to further elaborate on our congenital syphilis rabbit model. Attempts were made to determine whether in utero exposure to Treponema pallidum would stimulate immune reactivity and whether this activity would, in turn, affect lesion development upon challenge infection. Newborn rabbits aged 2 or 5 weeks were obtained from control does or from does infected intravenously with T. pallidum during pregnancy. Congenitally infected newborns exhibited increased immunologic functions. Concanavalin A-induced T-lymphocyte proliferation was elevated at both 2 and 5 weeks. In addition, macrophage Ia expression and RPR antibody titers were increased at 5 weeks. In separate experiments, newborn rabbits from control does or from does infected during pregnancy were challenged intradermally with viable organisms at either 2 or 5 weeks of age. Subsequent lesion severity was markedly increased in those newborns previously exposed to treponemes in utero. These observations further strengthen our model for congenital transmission of T. pallidum during pregnancy. We propose that at least some of the tissue pathology in syphilitic infection is associated with activated host defenses.
PMCID: PMC257930  PMID: 2019448
16.  Congenital syphilis: A guide to diagnosis and management 
Paediatrics & Child Health  2000;5(8):463-469.
Although congenital syphilis is a rare disease in Canada, infected infants may experience severe sequelae, including cerebral palsy, hydrocephalus, sensorineural hearing loss and musculoskeletal deformity. Timely treatment of congenital syphilis during pregnancy may prevent all of the above sequelae. However, the diagnosis of suspected cases and management of congenital syphilis may be confusing, and the potential for severe disability is high when cases are missed. The present review provides assistance to practitioners in the diagnosis of suspected cases and management of children with presumed or confirmed infection.
PMCID: PMC2819963  PMID: 20177559
Congenital syphilis
17.  Influence of antenatal screening on perinatal mortality caused by syphilis in Swaziland. 
Genitourinary Medicine  1988;64(5):294-297.
In a survey of 283 deliveries in Swaziland, active syphilis (positive results in the Treponema pallidum haemagglutination assay (TPHA) and the rapid plasma reagin (RPR) test) was found in 37 (13.1%) and possibly active infection (positive TPHA but negative RPR test results) in a further 87 (30.7%). The perinatal mortality of untreated mothers with active disease was 21.9% (7/32). The RPR test carried out antenatally by nurses had a sensitivity of 36% (13/36) and predictive accuracy of 48% (13/27). Awareness of this incidence of syphilis led to improved antenatal clinic measures and the prophylactic treatment of all newborn infants. More comprehensive serology is discussed and the prophylactic treatment of mothers considered. The need for health education aiming at safer sexual practices is of paramount importance in a society facing the arrival of the human immunodeficiency virus.
PMCID: PMC1194246  PMID: 3203929
18.  Retrospective Analysis of the Serologic Response to the Treatment of Syphilis During Pregnancy 
Objective: The purpose of this study was to assess the effect of several maternal variables on the serologic response following the treatment of syphilis in pregnancy.
Methods: A 5-year chart review identified 95 patients coded with syphilis at Hermann Hospital. Inclusion criteria were 1) serologically confirmed syphilis infection during the index pregnancy, 2) complete treatment during the index pregnancy, and 3) minimum of one follow-up rapid plasma reagin (RPR) titer. Forty-nine of 95 patients met the inclusion criteria. Treatment response was evaluated by comparing each post-treatment titer of a patient to her pretreatment titer. Each comparison was considered an “observation.” Each observation was classified as either a positive response (≥4-fold titer decline) or a negative response (<4-fold titer decline). Maternal variables assessed included 1) prior history of syphilis untreated or incompletely treated prior to the index pregnancy, 2) gestational age, 3) titer level, 4) unknown duration, 5) positive response at 1 month, 6) positive response at 2 months, 7) positive response at >3 months, and 8) race.
Results: A positive response following treatment was significantly more likely if there was no prior history of syphilis or if there was a high initial RPR titer (>32). Only 33/54 (61%) observations at or greater than 3 months had a positive response.
Conclusions: Our study suggests that an absence of a history of syphilis and an initial high RPR titer are predictive of a positive response following appropriate treatment. Given the low percentage of observations with a positive response at 3 months, we speculate that we may be undertreating our pregnant patients with syphilis infection.
doi:10.1155/S1064744997000070
PMCID: PMC2364528  PMID: 18476130
19.  Seroreversion of the serological tests for syphilis in the newborns born to treated syphilitic mothers. 
Genitourinary Medicine  1995;71(2):68-70.
BACKGROUND--IgG antibodies from mothers adequately treated for syphilis can cross the placenta and appear in the sera of healthy newborns without infection. In such infants, a false diagnosis of congenital syphilis is often made. We have designed a retrospective survey to determine the time of seroreversion of the serological tests for syphilis (STS) in uninfected newborns born to mothers who were adequately treated for syphilis. MATERIALS AND METHODS--Fifty two seropositive, untreated newborns born to 51 mothers treated for syphilis were studied. The newborns were followed at 1, 3, 6, 9, and 12 months of age until seroreversion was detected. The VDRL test was followed until 12 months in 12 of the 22 newborns who were positive at birth, the TPHA in 21 of the 46 newborns, and the FTA-ABS test in 22 of the 48 newborns. RESULTS--In the first serological tests done within 1 month after birth, the VDRL was positive in 22 newborns (42%), the TPHA in 46 (88%), and FTA-ABS in 48 (92%). The VDRL seroreverted within 6 months after birth in 84%, and within 1 year in 100%. The TPHA test seroreverted in 95% within 1 year after birth. The FTA-ABS test seroreverted in 100% within 1 year after birth. CONCLUSIONS--In most seropositive, untreated newborns born to treated mothers the VDRL became negative within 6 months after birth and the TPHA and FTA-ABS within 1 year. This result is consistent with current Centers for Disease Control (CDC) guidelines. However, although the CDC guidelines are adequate in general, we think that some revision is desirable concerning the IgM test and combination of the test results in order to rule out congenital syphilis in seropositive, nonsymptomatic newborns born to the treated mothers.
PMCID: PMC1195455  PMID: 7744415
20.  Congenital syphilis, still a reality 
Congenital syphilis is a potentially serious pathology affecting newborns of infected mothers. Even one case of congenital syphilis is a sentinel public health event, since timely diagnosis and treatment of syphilis infected pregnant woman should prevent transmission almost entirely. Here, we are reporting a case of early symptomatic congenital syphilis presented with severe desquamating papulosquamous lesions over multiple body parts along with erosive lesions around oral cavity and nostrils.
doi:10.4103/0253-7184.112941
PMCID: PMC3730478  PMID: 23919058
Congenital syphilis; treponema pallidum; venereal disease research laboratory
21.  Experimental model of congenital syphilis. 
Infection and Immunity  1993;61(8):3559-3561.
Female LSH hamsters infected with Treponema pallidum subsp, endemicum before pregnancy or during early pregnancy transmit a form of syphilis to the fetus that is similar to human congenital syphilis. The offspring develops rhinitis, skin rash, failure to thrive, and hepatosplenomegaly. T. pallidum is detectable in their livers, spleens, and nasal secretions. Immunoglobulin M antibodies are detected in the serum.
Images
PMCID: PMC281041  PMID: 8335390
22.  IgM-FTA test in syphilis in adults. Its relation to clinical findings. 
IgM-FTA tests have been carried out on 209 sera from 169 patients with treated or untreated syphilis at various stages and on 128 sera from 109 patients, born in areas where yaws is or was prevalent, with treated or untreated latent treponemal disease. IgM anti-treponemal antibody was found in virtually all cases of untreated early or early latent syphilis but in only 23 per cent. of sera from patients with untreated late latent syphilis. After treatment the antibody usually disappeared within one year, but it persisted in a minority of patients, including some treated for late symptomatic or congenital syphilis. Except in isolated cases there was no clinical evidence to suggest continued disease activity, although a third of the patient in whom the antibody persisted for more than 2 years after treatment were noted to be homosexuals. The test may assist in differentiating untreated early latent from late latent syphilis.
PMCID: PMC1045269  PMID: 786436
23.  First trimester prenatal diagnosis of congenital rubella: a laboratory investigation. 
Acute primary maternal infection with rubella virus during pregnancy often, but not invariably, leads to the congenital rubella syndrome. Diagnosis by detection of virus specific IgM in the mother is not always possible, and in those cases in which IgM is detected the fetus has not necessarily also been infected. A method for direct, prenatal detection of fetal infection would allow more accurate early diagnosis of congenital rubella syndrome. In this study a case of suspected preconception rubella infection that was not referred until 14 weeks after the appearance of a rash was studied to determine whether a retrospective serological diagnosis of primary rubella could be made, and whether direct evidence of fetal infection could be obtained from a chorionic villus biopsy specimen by detecting virus specific antigens or ribonucleic acid (RNA) sequences. Monoclonal antibodies and a cloned complementary deoxyribonucleic acid probe were used successfully to detect antigens to rubella virus antigens and RNA sequences in the chorionic villus biopsy specimen, which was taken at 15 weeks' gestation. This method should serve as a new approach to the diagnosis of congenital rubella syndrome in utero.
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PMCID: PMC1339854  PMID: 3083942
24.  Value of serological diagnosis in congenital syphilis. Report of nine cases. 
The diagnosis of congenital syphilis is difficult since it depends mainly on the results of serological tests. The results of five serological tests (three specific and two non-specific) in nine neonates with congenital syphilis are compared with those obtained in three with passively acquired antibodies. It appeared that the serological diagnosis of congenital syphilis must be based on the finding of specific neonatal antibodies in cord serum, which give positive results to the fluorescent treponemal antibody absorption test for immunoglobulin M, together with high titres of total IgM and negative results to latex tests. The non-specific tests are useful for confirming the efficacy of treatment. The mean number of cases of congenital syphilis in Seville is 0.81/1000 live births.
PMCID: PMC1045835  PMID: 7448581
25.  FACTS AND FALLACIES ABOUT GONORRHEA AND SYPHILIS 
California Medicine  1959;91(4):179-184.
The limitations and special usefulness of clinical and laboratory diagnostic techniques in the diagnosis of gonorrhea are poorly understood and utilized by the average practitioner today. Most physicians and clinics, lulled by complacency or lack of ancillary aid in the area of diagnosis, proceed by measures based in many instances upon past fallacy rather than upon the facts recently developed by research in this disease. The same circumstances apply concerning treatment and management of this disease, particularly in females.
All physicians are potentially capable of giving excellent treatment for syphilis today. The problem is to properly diagnose the disease, manage the patient and deal with the source. Looming large in the area of diagnosis is the interpretation of serologic tests for syphilis. No serologic test diagnoses syphilis, but rather gives information as to the immunologic status of the the patient in relation to reagin and treponemal antibodies. None of the antibodies measured in these tests are absolutely specific for syphilis alone.
There is no substitute for a well-informed physician, who knows his patient, to relate and interpret even the best of treponemal serologic tests.
PMCID: PMC1577788  PMID: 13826689

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