Congenital syphilis is a clinical form of syphilis that occurs when a child is infected with pale treponemas in utero. Disease can manifest itself in various periods of a child’s life from prenatal to adolescent. It is characterized by a specific syphilitic lesion of the skin, mucous membranes, bone tissue, somatic organs and nervous system. Diagnosis is based on the isolation of the pathogen from the blood, the separated skin elements and cerebrospinal fluid; positive results of serological reactions and PCR diagnostics, examination of the state of internal organs. Treatment of congenital syphilis is carried out with antibiotics, bismuth preparations and non-specific means aimed at improving immunity.
A50 Congenital syphilis
Syphilis is one of the most common sexually transmitted diseases. Along with gonorrhea, chlamydia, cytomegaly and trichomoniasis, it is a sexually transmitted infection. In addition to sexual transmission, infection can occur in utero and lead to the development of congenital syphilis. A child with this disease poses an infectious danger to others, especially if the disease occurs with skin manifestations.
The disease is caused by the transmission of infection from a sick mother during intrauterine development. Pale treponema (causative agent of syphilis) unable to pass through a healthy transplacental barrier. However, syphilis in women during pregnancy leads to damage to the placenta and causes a violation of its protective barrier function. As a result, treponemes penetrate into the fetal body.
Transmission of treponemes from the mother to the fetus is most likely in the first years of the mother’s illness, over time this ability fades. The risk of having a child is especially high in women with a secondary form of this disease, accompanied by dissemination of the pathogen with blood flow. In a fetus infected with treponemes, lesions of internal organs develop only at the 5th-6th month of pregnancy. Therefore, anti-syphilitic treatment carried out in the early stages can lead to the birth of a healthy child.
Depending on the features of the course and the timing of the appearance of its clinical signs, venereology identifies 4 main forms of the disease.
Fetal syphilis develops during the intrauterine period, but not earlier than the 5th month of pregnancy. It is characterized by compaction and enlargement of internal organs (especially the liver and spleen), which occurs due to their inflammatory infiltration. The formation of infiltrates in the lungs leads to the development of “white” pneumonia of the fetus. The most reliable criterion confirming congenital fetal syphilis is the X-ray detection of signs of specific osteochondrosis in the fetus. The occurrence of congenital syphilis during intrauterine development can cause premature birth, late miscarriage, stillbirth or the birth of a sick child.
Early congenital syphilis manifests itself in a child under the age of 2 years and is divided into congenital syphilis of infancy and syphilis of early childhood. In infants, symptoms may appear during the first 1-2 months of life. Most often, this is a lesion of the skin and mucous membranes with the development of syphilitic pemphigus.
Typical symptoms in infants are also syphilitic runny nose and Gohsinger infiltration. Syphilitic runny nose has a long course with pronounced swelling of the mucous membrane, abundant mucous discharge, pronounced difficulty in nasal breathing. It can lead to damage to the bone-cartilaginous structures of the nose with the formation of saddle deformity. Gokhzinger’s infiltration is expressed by the appearance of a dense infiltrate (syphilis) in the area of the chin and lips, on the soles, buttocks and palms at the 8-10 weeks of life of a child with congenital syphilis. The child’s lips are thickened and swollen, crack and bleed, the skin of the affected areas loses elasticity, thickens, its folds are smoothed.
With congenital syphilis of infancy, ulcerative lesions of the larynx may occur with the appearance of hoarseness of the voice. Bone tissue lesions are manifested by osteochondritis and periostitis of mainly long tubular bones. As with secondary syphilis, specific lesions of somatic organs caused can be observed: hepatitis, myocarditis, pericarditis, endocarditis, glomerulonephritis, hydrocephalus, meningitis, meningoencephalitis. Boys often have specific orchitis, sometimes dropsy of the testicle. Lung damage in congenital syphilis occurs with the development of interstitial diffuse pneumonia, which often leads to the death of a child in the first days of life.
In early childhood, disease can manifest itself with eye diseases, damage to the nervous system and limited skin manifestations in the form of a few large papules and wide condylomas. With congenital syphilis in young children, lesions of internal organs are less pronounced. Changes in bone tissue are detected only on radiographs.
Late congenital syphilis begins to manifest clinically after 2 years of age, most often in adolescence (14-15 years). Its symptoms are similar to the picture of tertiary syphilis. These are gummous or tubercle syphilis localized on the trunk, face, limbs, nasal mucosa and hard palate. They quickly disintegrate with the formation of ulcers. Common symptoms of late congenital syphilis include specific gonitis, saber-shaped shins, as well as dystrophic changes (stigmas) caused by the influence of the pathogen on the emerging tissues and organs. Stigmas are non-specific in nature and can be observed in other infectious diseases (for example, tuberculosis). Getchinson’s triad is specific for late congenital syphilis: syphilitic labyrinthitis, diffuse keratitis and Getchinson’s teeth — dystrophic changes in the central upper incisors.
Latent congenital syphilis can be observed in a child at any age. It occurs in the complete absence of clinical symptoms and is detected only by the results of serological studies.
The diagnosis is confirmed by the detection of pale treponemas in the contents of the bubbles of syphilitic pemphigus or separated ulcers. However, in the absence of skin manifestations, it is not possible to apply this diagnostic method. Identification of the causative agent in congenital syphilis can be carried out by microscopic examination of the cerebrospinal fluid obtained as a result of lumbar puncture. But the negative result of this study does not exclude the presence of a latent form of congenital syphilis.
Serological reactions play a crucial role in the diagnosis of congenital syphilis. Non-specific studies (Wasserman reaction, RPR test) can give false positive results. Therefore, if congenital syphilis is suspected, specific serological studies are also widely used: RIF, RIBT, RPGA. PCR detection of pale treponema is carried out with blood, scraping, separating the skin elements of patients with congenital syphilis. The accuracy of the result is 97%.
Diagnosis of syphilitic lesions of various internal organs may include consultation of a pulmonologist, neurologist, hepatologist, nephrologist, oculist, otolaryngologist, lung x-ray, bone radiography, ultrasonography, ECHO-EG, lumbar puncture, ultrasound of the abdominal cavity and liver, ultrasound of the kidneys, etc.
Congenital syphilis treatment
Pale treponema, unlike most other microorganisms, still remains highly sensitive to the effects of penicillin antibiotics. Therefore, the main therapy for congenital syphilis consists in the long-term systemic administration of penicillins (benzylpenicillins in combinations and in combination with ecmoline). If a child has an allergic reaction to penicillin or treponema resistance is detected according to the results of bacposev with an antibioticogram, treatment is carried out with erythromycin, cephalosporins or tetracycline derivatives.
In cases of the nervous system with the development of neurosyphilis, endolumbal administration of antibiotics and pyrotherapy (prodigiozan, pyrogenal), improving their penetration through the hemato-encephalic barrier, is indicated. In the treatment of late congenital syphilis, along with antibiotic therapy, bismuth preparations (bismoverol, biyoquinol) are prescribed. Vitamins, biogenic stimulants, and immunomodulators are also used.
The main preventive measure in the prevention is a mandatory two-time serological examination of all pregnant women for syphilis. If a positive serological reaction to syphilis is detected, a follow-up examination of the woman is carried out. The diagnosis of syphilis in the early stages of pregnancy is a medical indication for an abortion. With the continuation of pregnancy, but an early start of treatment in a woman infected with syphilis, it is possible to give birth to a healthy child.