Congenital syphilis - Revision history

Aidan at 10:57, 1 March 2023

2023-03-01T10:57:31Z

← Older revision		Revision as of 10:57, 1 March 2023
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	*At birth, two thirds of affected neonates are asymptomatic, with disease developing over the following 6 weeks		*At birth, two thirds of affected neonates are asymptomatic, with disease developing over the following 6 weeks
	*Early disease, within the first two years, includes:		*Early disease, within the first two years, includes:
	**At birth: [[Causes::necrotizing funisitis]]		**At birth: [[Causes::necrotizing funisitis]] ("barbershop pole" umbilical cord)
	**Shortly after birth:		**Shortly after birth:
	***[[Causes::Rhinitis]]: called [[Causes::snuffles]], often bloody and copious, which is often the first manifestation and present in about 40% of cases		***[[Causes::Rhinitis]]: called [[Causes::snuffles]], often bloody and copious, which is often the first manifestation and present in about 40% of cases
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	==Management==		==Management==

	*Treat syphilis in pregnancy with ~~high-dose~~ penicillin to prevent congenital syphilis		*Treat syphilis in pregnancy with penicillin to prevent congenital syphilis
			*For infants that require treatment, the treatment of choice is [[Is treated by::crystalline penicillin G]]
	*Treat affected infant with [[Is treated by::penicillin G]] 50,000 U/kg/day IV q12h for the first 7 days of life, followed by q8h to complete a total of 10 days
			**Age 1 to 7 days: 50,000 U/kg IV q12h
			**Age 1-4 weeks: 50,000 U/kg q8h
			**Age >4 weeks: 50,000 U/kg q6h
			*Duration is typically 10 days
			**Don't forget to dose adjust from q12h to q8h after the first 7 days
	*Can treat lower-risk infants with [[Is treated by::benzathine penicillin G]] 50,000 U/kg IM once		*Can treat lower-risk infants with [[Is treated by::benzathine penicillin G]] 50,000 U/kg IM once

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	\|10 days		\|10 days
	\|}		\|}

			* Serology includes RPR and treponemal tests
			** In the absence of congenital syphilis, RPR declines by about three months and is usually non-reactive by 6 months, and treponemal tests usually clear by 12 months and always by 18 months
			* Investigations include long-bone x-rays, CBC, and CSF (for glucose, protein, and VDRL), ± ophthalmological and audiological tests
			* Skin lesions, nasal discharge, placental lesions, and the umbilical cord can be sent for darkfield microscopy or DFA testing

	===US Guidelines===		===US Guidelines===
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	*LP should be sent for VDRL, cell count, protein		*LP should be sent for VDRL, cell count, protein
	*CBC with differential for platelet count		*CBC with differential for platelet count

			== Further Reading ==

			* [https://cps.ca/en/documents/position/congenital-syphilis Congenital syphilis: No longer just of historical interest]. Canadian Paediatric Society Practice Point, reaffirmed 2018.

	[[Category:Sexually-transmitted infections]]		[[Category:Sexually-transmitted infections]]

Aidan: /* Clinical Manifestations */

2023-02-28T21:56:10Z

Clinical Manifestations

← Older revision		Revision as of 21:56, 28 February 2023
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	*At birth, two thirds of affected neonates are asymptomatic, with disease developing over the following 6 weeks		*At birth, two thirds of affected neonates are asymptomatic, with disease developing over the following 6 weeks
	*Early disease, within the first two years, includes:		*Early disease, within the first two years, includes:
	**At birth: [[Causes:necrotizing funisitis]]		**At birth: [[Causes::necrotizing funisitis]]
	**Shortly after birth:		**Shortly after birth:
	***[[Causes::Rhinitis]]: called [[Causes::snuffles]], often bloody and copious, which is often the first manifestation and present in about 40% of cases		***[[Causes::Rhinitis]]: called [[Causes::snuffles]], often bloody and copious, which is often the first manifestation and present in about 40% of cases

Aidan at 17:15, 2 February 2022

2022-02-02T17:15:01Z

← Older revision		Revision as of 17:15, 2 February 2022
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	*Rare, with about 20 per 100,000 live births in the US		*Rare, with about 20 per 100,000 live births in the US
	*Greatest risk to child is with untreated primary [[Syphilis in pregnancy\|maternal syphilis]]		*Greatest risk to child is with untreated primary [[Syphilis in pregnancy\|maternal syphilis]], and almost exclusively to those mothers with an RPR titre of 1:8 or greater

	===Pathophysiology===		===Pathophysiology===

Aidan at 16:21, 20 September 2020

2020-09-20T16:21:40Z

← Older revision		Revision as of 16:21, 20 September 2020
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	[[Category:Sexually-transmitted infections]]		[[Category:Sexually-transmitted infections]]
	[[Category:Congenital infections]]		[[Category:Congenital infections]]
	[[Category:Pediatrics]]

Aidan at 12:29, 19 September 2020

2020-09-19T12:29:02Z

@@ Line 16: / Line 16: @@
 *At birth, two thirds of affected neonates are asymptomatic, with disease developing over the following 6 weeks
 *Early disease, within the first two years, includes:
 *Late disease, after the first two years, includes:
 ==Diagnosis==

Aidan at 18:15, 20 August 2020

2020-08-20T18:15:54Z

← Older revision		Revision as of 18:15, 20 August 2020
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	[[Category:Sexually-transmitted infections]]		[[Category:Sexually-transmitted infections]]
			[[Category:Congenital infections]]
	[[Category:Pediatrics]]		[[Category:Pediatrics]]

Aidan at 17:55, 20 August 2020

2020-08-20T17:55:10Z

← Older revision		Revision as of 17:55, 20 August 2020
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	*Rare, with about 20 per 100,000 live births in the US		*Rare, with about 20 per 100,000 live births in the US
	*Greatest risk to child is with untreated primary maternal syphilis		*Greatest risk to child is with untreated primary [[Syphilis in pregnancy\|maternal syphilis]]

	===Pathophysiology===		===Pathophysiology===
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	*Can treat lower-risk infants with [[Is treated by::benzathine penicillin G]] 50,000 U/kg IM once		*Can treat lower-risk infants with [[Is treated by::benzathine penicillin G]] 50,000 U/kg IM once

	===Canadian ~~guidelines~~===		===Canadian Guidelines===

	*Treat infants at birth if:		*Treat infants at birth if:
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	\|}		\|}

	===US ~~guidelines~~===		===US Guidelines===
	{\| class="wikitable"		{\| class="wikitable"
	! colspan="2" \|Initial neonatal assessment		! colspan="2" \|Initial neonatal assessment

Aidan: /* Canadian guidelines */

2020-08-20T17:54:35Z

Canadian guidelines

← Older revision		Revision as of 17:54, 20 August 2020
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	**Symptomatic		**Symptomatic
	**Infant's RPR at least four-fold higher than mother's		**Infant's RPR at least four-fold higher than mother's
	**Maternal treatment inadequate, did not contain penicillin, is unknown or occurred in the last month of pregnancy, or if the maternal serologic response is inadequate		**Maternal treatment inadequate, did not contain [[penicillin]], is unknown or occurred in the last month of pregnancy, or if the maternal serologic response is inadequate
	**Adequate follow-up ~~cannt~~ be ensured		**Adequate follow-up can't be ensured
			*Specific scenarios are described in the table below

	{\| class="wikitable sortable"		{\| class="wikitable sortable"

Aidan: /* Canadian guidelines */

2020-08-13T00:39:06Z

Canadian guidelines

Show changes

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-14T16:32:46Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 16:32, 14 July 2020
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	* Can be transmitted during delivery, as well		* Can be transmitted during delivery, as well

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==
	* Mothers typically have had no prenatal care		* Mothers typically have had no prenatal care
	* To the fetus, can cause [[Causes::spontaneous abortion]] (40% in untreated primary syphilis), [[Causes::preterm delivery]], [[Causes::polyhydramnios]], [[Causes::intra-uterine growth restriction]], [[Causes::hydrops fetalis]], or [[Causes::intra-uterine fetal demise]]		* To the fetus, can cause [[Causes::spontaneous abortion]] (40% in untreated primary syphilis), [[Causes::preterm delivery]], [[Causes::polyhydramnios]], [[Causes::intra-uterine growth restriction]], [[Causes::hydrops fetalis]], or [[Causes::intra-uterine fetal demise]]