Syphilis is a bacterial sexually transmitted infection caused by Treponema pallidum. The disease remains the most common congenital infection worldwide. The World Health Organization (WHO) estimates that, globally, 1.5 million pregnancies are affected by syphilis each year and up to 50% of those who are not treated will experience adverse outcomes such as congenital syphilis. Syphilis infection during pregnancy related with miscarriage, stillbirth or neonatal death shortly after delivery. Globally, syphilis remains prevalent in Africa, South America, Southeast Asia and Eastern Europe. If a pregnant woman has syphilis, motherto-child transmission can occur, potentially causing serious adverse outcome including low birth weight, stillbirth and congenital syphilis. For this reason, infection remains part of the antenatal screening program. Only 40% of women with positive screening results require antibiotic treatment for the condition. This is because patients who screen positive may have an inadequately treated infection acquired before conception, a false-positive result, or an inflammatory condition. The stage of maternal syphilis affects the risk of transmission to the fetus as high as 100% in primary syphilis, whereas the risk is much lower in early and late latent syphilis, with transmission rates of 40% and 10%, respectively. Syphilis can seriously make complicated pregnancy and result in spontaneous abortion, stillbirth, non-immune hydrops, intrauterine growth restriction, and perinatal death, as well as serious outcome in live-born infected children. While appropriate treatment for pregnant women often prevents these complications, the main obstacle is the inability to identify infected women and put them on treatment.
Timely diagnosis and proper management of infection in pregnant women are important to prevent adverse outcomes. Syphilis is a sexually transmitted disease caused by the spirochete Treponema pallidum. It is of special concern during pregnancy because can lead to adverse pregnancy outcomes and congenital syphilis. This study retrospectively included female patient with laboratory-confirmed syphilis in East Java. Demographic, pregnancy record, clinical, radiological, laboratory, and treatment data were reviewed from medical record and health of both mother and child book.
The patient was 40-year-old multiparous pregnant women was referred to the hospital at 40 weeks of gestation due to early latent syphilis. The patient was diagnosed during the last trimester and had not been treated, but no vulvar and anal genital wart was found. Patient was scheduled to urgent section caesarean but 1 hour after admitted to the hospital, patient had spontaneous delivery. A healthy son was born (3400 g /50 cm, 10 points Apgar score). Due to the lack of documentation regarding treatment of maternal syphilis, crystalline penicillin was administered to the newborn. Screening and early penicillin treatment are the most important factors that can eliminate complications related to the prenatal contagion with Treponema pallidum. Yet despite the lack of treatment or its inappropriate administration, the pregnancy complicated with maternal syphilis may end in a completely different way.
Spirochetes of Treponema pallidum can cross the placenta and infect the fetus starting at about 14 weeks of gestation, and the risk of fetal infection increases with gestational age. However, the manifestations and outcomes of congenital syphilis are influenced by gestational age, maternal syphilis stage, maternal medication, and fetal immunologic response. Congenital syphilis can cause spontaneous abortion, usually after the first trimester, or stillbirth at term is found in 30 to 40 percent of cases, or premature, or full-term birth in a live baby but may have obvious signs of infection or have no symptoms at all once (about two-thirds of the time live births). Placental infection and decreased blood flow to the fetus are the most common causes of fetal death. Untreated women have about a 70% chance of fetal infection during the first 4 years of disease. In 35% of cases, infected fetuses are born alive with congenital syphilis. Low birth weight can be the only sign of infection. In fact about 60% of live births are asymptomatic at birth. In this patient, there were no signs of infection either in the mother or in the fetus, but further examination needs to be done to prevent the bad condition and the possibility of congenital syphilis being undetected during delivery. Adequate treatment of maternal infections is effective for preventing maternal-to-fetal transmission and for treating fetal infections. The treatment is Penicillin G, which is administered parenterally. In this case there is no problem in giving antibiotics. Treatment failure has been described in several case reports, particularly in patients with HIV infection, but no penicillin resistance has been documented in T. pallidum. The CDC recommends that pregnant women should be treated with a penicillin regimen appropriate for their stage of infection. In primary, secondary, and early latent syphilis, benzathine penicillin G 2.4 million units IM in a single dose is recommended.Additional therapy may benefit pregnant women in some situations. Some authors suggest that a second dose of benzathine penicillin 2.4 million units IM be administered 1 week after the initial dose for women with primary, secondary, or early latent syphilis.
Author: Eighty Mardiyan Kurniawati, Rizqy Rahmatyah, Velyana Lie, Achmad Rheza
Detailed information from this research can be seen on our article at:
https://journal2.unusa.ac.id/index.php/MHSJ/article/view/2412/1594
Kurniawati, E. M., Rahmatyah, R., Lie, V., & Rheza, A. (2022). Pregnancy with Early Latent Syphilis, a reality in 21st century: a case report and literature review. Medical and Health Science Journal, 6(1), 41–46. https://doi.org/10.33086/mhsj.v6i1.2412
