Syphilis in pregnancy: risks to mother and fetus, treatment

Among all sexually transmitted infections the most notorious is syphilis. In our country today, there is a decrease in the incidence of this infection, the peak accounted for 90-ies of the last century.

If to speak about the issue in General – she’s serious, but infection with syphilis during pregnancy is a particular risk in connection with the extremely negative and dangerous effects on the fetus of the pathogen, likely even several months after treatment.

Today, cases of syphilis are recorded periodically during pregnancy and childbirth, which causes problems. What is so dangerous infection, what to do if you suspect this disease?

What is syphilis, what is dangerous?

Syphilis belongs to the group of infectious microbial diseases occurring in the chronic form. The main cause of disease is infected with pale Treponema, a bacterium specific form which has a number of special properties. Mainly women are infected sexually, making syphilis a venereal disease (group STD).

Of all these diseases, syphilis is the most difficult and dangerous, because it leads to damage of many tissues and organs most women, and is also transmitted in utero to the fetus, leading to serious problems of the child and congenital infection.

Infection characteristic undulating, and relapsing course, with periods of attenuation of symptoms and the emergence of a new wave of more dangerous and serious. From the moment of infection Treponema pallidum penetrate into the blood vessels, the blood circulating in all organs and tissues, affecting also the reproductive and placenta, the fetus. The activity of the parasite will remain very long without treatment it lives in the body over the years, gradually leading to irreversible phenomena. Even in periods of latent course of the disease it never ceases to be dangerous for the patient and the people around him.

Classification of infection is during pregnancy

The disease at the time of occurrence are divided into acquired and congenital. If we are talking about acquired syphilis, it develops after unprotected sex with an infected partner. Congenital syphilis is formed when infected by the mother during pregnancy with the transmission in gestation or childbirth.

Stages of infection is divided into:

• the incubation period lasting 3 to 4 weeks, no symptoms in this age no, Treponema pallidum actively multiplies and infects the genitals and internal organs.
• the primary stage of syphilis, occurring during the first 45 days from the moment of infection,
• secondary infection, is a period of 2-4 years from the time of infection,
• tertiary syphilis, which lasts until 5-15 years after infection.

Features of infection

Infection with syphilis occurs through sexual contact with a sick partner, household infection infections unlikely and not confirmed by physicians. During pregnancy a woman can spread syphilis to the fetus in utero, as Treponema are able to cross the placenta. The most dangerous period for infection of the child is the second trimester, and the most dangerous a mother in the secondary phase of infection, and duration in the first three years after infection.

In each stage its typical manifestation, which is worth knowing.

Symptoms of syphilis in women during pregnancy

In the first stage, during primary infection, syphilis formed specific pattern – formation of the chancre. A small round or elongated reddened area with a Central erosion painless flow, which then ulcerative defect reaches a size of 2 cm wound Edges are raised, detachable from the surface is scarce, often can form a crust.

No pain like the chancre, not form, usually develops in the region where the Treponema has penetrated. For women it is the vagina or cervix, clitoris or vulva.

With secondary syphilis develop a rash in the genital area and the skin of the body, in addition, typically the hair loss. Affects internal organs and the nervous system, the duration of such period of 2-3 years. Gradually, the syphilis goes into a latent period, when the skin has no rash, infection activity is declining, but internal organs are invariably destroyed.Found such education less frequently due to the fact that they are invisible to the eye in the vagina or on the cervix. It is also possible the formation of chancre in other atypical areas, oral cavity or rectum, Breasts, legs or hands. The appearance of education has increased regional lymph nodes, they are enlarged and painless. Period lasts 6-7 weeks.

When tertiary late syphilis typical lesions in the liver and heart, cartilage, nose and nervous system, death occurs from complications of neurosyphilis. Today, such manifestations are rare, in this condition, the disease is generally start.

Symptoms during pregnancy is typical, but can be somewhat brighter and last longer. Tertiary syphilis in pregnant women practically does not occur, pregnancy is almost impossible due to serious lesions of the genitals with absence of ovulation and multiple commissural processes in pelvis.

The most common variant is the presence during pregnancy of latent syphilis, when there are no symptoms, the woman feels healthy and bears fruit.

Infection detected in the tests that requires immediate consultation of an obstetrician, doctor, and additional specialists. This is due to the current infection and the risk to the fetus.

The consequences of syphilis for pregnancy

Syphilis does not go unnoticed for pregnancy, usually in the early stages of pregnancy Treponema pallidum causes miscarriages until the time of 14-16 weeks, and a higher chance of stillbirth and premature birth. In pregnancy, the condition of the suffering, violated the function of internal organs and tissue that faces the placental insufficiency, intrauterine infection of the fetus and the birth of a child with the manifestations of congenital syphilis with malformations or apparently normal, but with persistently positive blood reactions. Laboratory findings found in the body of a child Treponema pallidum, transmitted to him from his mother.

For a long time after treatment of syphilis is high chances of problems with pregnancy and the birth of a sick baby. It depends on the time when a woman had contracted syphilis and the amount of therapy that she had undergone. The child becomes infected, usually after the 5th month of pregnancy, although it is possible that the earlier episodes.

The consequences of syphilis for the fetus and child

Even more dangerous syphilis for the fetus and to the developing fetus. First of all, in the early stages of this miscarriage with a sinking of pregnancy, and up to 30 weeks at high risk of stillbirth. This is due to multiple lesions of the internal organs of the fetus, lesions of the lung tissue, liver, and spleen, and kidneys.

Under the action of the Treponema tissue of the lungs in the fetus undergoes degeneration, forming foci of infiltration and thickening, which leads to disruption of the formation of alveoli and filling in their epithelial cells. Such light will not be able to fully open during the period of the first breath.

No less dangerous to the fetus insufficiency of the placenta, which under the action of the Treponema shrinks and thickens, it narrows the blood vessels, which leads to chronic fetal hypoxia and death. Children usually die in utero, but if they survive, the diagnosis of congenital syphilis.

For the clinical manifestations of congenital syphilitic infection is very specific, they are not like any other disease.

The presence of certain symptoms, the doctor may suspect syphilis in the fetus even without tests. The most characteristic ones include:

• infiltration of Gachinger, specific skin lesions, which are formed approximately 7-8 weeks of life crumbs. Epithelium of the palms and soles, nasolabial triangle, buttocks thickens and reddens, becomes polished shiny look. These areas lose their elasticity, they form scars and cracks, peeling of the epithelium.
• syphilitic pemphigus, stood on the palms and feet the vesicles, and similar elements in the legs and torso. Inside the bubbles there is a murky contents, they gradually merge into the larger elements, forming a crust and opened erosions that bleed.
• syphilitic rhinitis, emerging to 4 weeks of a child’s life. Affects the mucous of the nose, difficulty breathing, which can lead to problems with breastfeeding. Gradually, the lesion affects the bone and cartilaginous part of the nose, leading to deformation of the nose and violation of its basic functions.
• the formation of Legg – violation of bone growth and bone deformation, which is detected according to x-ray. In advanced stages of disease can be formed about paralysis, in which the limb flaccid, they practically are not involved in the activity of the baby.
• the development of meningitis, inflammation of the meninges, which is manifested in the form of convulsions and hydrocephalus, strabismus, and paresis. In parallel with these symptoms, the doctor notes a deformity in the bones of the skull, the predominance of the cerebral part above the facial region, bulging of the frontal tubercles.
• the formation of chorioretinitis, the formation of specific inclusions and plaques in the region of the fundus.
• hair loss with the formation of alopecia.

The identification of even a couple of these signs allows the diagnosis of congenital syphilis and begin treatment of the baby.

In addition, for congenital syphilis in the infant of a typical specific triad of Hutchinson. It manifests itself in any of the current infection in the mother, and allows you to accurately and without doubt identify congenital syphilis in the child.

This complex includes three mandatory symptom, emerging in all infants with congenital syphilitic lesion:

• parenchymatous keratitis, is a complete or partial clouding in the cornea that affects both eyes. Perhaps from completely reversible to the total, with complete blindness.
• lose teeth with dystrophic processes in their beginnings, when the eruption is that are formed screwdriver or barrel-shaped.
• Lehota labyrinthine origin, occurring as a late symptom of congenital syphilis. It can occur in the period from 7 to 14 years, and initially, the episodes of hearing loss are temporary, passing gradually into irreversible defeat.

The consequences can even reach for a long time, it is possible to have syphilis early age. It starts in period 1 to 2 years and can be congenital late syphilis manifestation of it in the period of 5-6 years, recorded positive tests for syphilis, although it may absolutely not be symptoms.

The analysis for syphilis in pregnant women: normal and decoding

During pregnancy all women are tested for this infection three times over the entire period. This allows in case of infection to identify the problem and begin active treatment. Research is being conducted at registration, then once in the second trimester and into the third. A negative result indicates the absence of Treponema and antibodies to it, and that’s for diagnosis of syphilis requires the presence of positive serological tests – the presence of antibodies to the Treponema.

All tests are divided into two large groups:

• Non-treponemal
• Treponemal.

The first group (non-treponemal tests) always give a positive reaction in the presence of syphilis, but can also give positive results against some other infections or abnormalities. They are used in order to determine the activity of the process is carried out thereon, the control of cure. Upon successful deletion of the Treponema from the body, they become negative.

The classic diagnosis of syphilis (Wassermann Reaction) often makes mistakes, therefore it is replaced with a more accurate and sensitive tests.

The second group (treponemal tests) have a high specificity and sensitivity, they have given positive results only against the backdrop of syphilis. However, they after infection can remain positive life that will point to the past process. Determine the level of antibodies to Treponema IFA with determination of IgM and IgG, and the first group says about the recent infection and acute process. Also shown are the other methods of research, clarifying the presence of Treponema and antibodies thereto.

The diagnosis is made if one positive test from the first group and at least 2 tests – of the second. If the results are questionable, the study was repeated after 1-2 weeks.

Treatment of syphilis in pregnancy

If pregnancy is detected on the primary or secondary process, to avoid extremely dangerous and difficult processes in relation to its own body and the body of the fetus, it is necessary to conduct at least two courses of treatment. The first will be the main, it is only performed stationary as soon as the diagnosis of syphilis. The second is carried out with the aim of prevention as an outpatient or in the hospital.

Detection of syphilis during the first or second trimester treatment in terms of diagnosis, then at the time of 20-24 weeks. In therapy they usually use penicillin antibiotics, and if there is their intolerance – Ceftriaxone. These funds are active against Treponema pallidum and do not have dangerous effects on the fetus.

Treatment of syphilis depending on the time of gestation varies. Before the deadline in the 4th month of pregnancy used the medication durantula of a number of long-term excreted from the body, and after this period, those that appear much faster. So, before the deadline of 18 weeks use bitsillin (1, 3 or 5) or penicillin, courses are selected depending on the drug. After 18-tynedale prescribe only penicillin or cephalosporins.

After the initial course of treatment so that the infection is as little as possible harm to a child must undergo a course of therapy for the rehabilitation of the body of the fetus.

It is held from the 20th week of gestation, provided that:

• specific treatment is carried out before pregnancy or in the first trimester, after which the tests become negative.
• have completed the main course of therapy until the time of the 18 weeks of gestation.

Assigned to prophylactic administration of penicillin, a course selected by the doctor. After such two-step treatment of the infection is stopped in its development, is not formed from the primary syphilis and secondary complications disappear skin changes and internal organ involvement. Thus, eliminated the threat to the health of a pregnant woman, it ceases to be contagious to others.

Due to modern schemes of treatment of syphilis if it is detected in the first two trimesters, it is possible to completely prevent congenital syphilis in the fetus. Detection of the infection is an indication for interruption of a wanted pregnancy, but after birth, the child will be screened for the infection and will long be monitored.

Childbirth in the presence of syphilis in women

If the first diagnosis was exposed during pregnancy, a woman is treated in the infectious hospital or observation Department of the specialized maternity hospitals, birth also being conducted in the observation office, in a separate room. Rules of delivery are the same, and that under normal conditions, and the option of delivery is selected based on testimony from the mother and fetus, vaginal delivery or cesarean did not affect the possibility of fetal infection or to prevent them.

After the birth of the placenta, it needs a thorough examination, laxity and fragility, large areas of degenerative phenomena threaten to violate the integrity of the body, and then maybe leaving the area of the placenta in the uterine cavity.

If there is any doubt that the placenta is intact, the mother is given anesthesia and is carried out by manual control of uterine cavity. The pieces of umbilical cord and placenta sent for histological diagnosis. This will confirm the infection of these organs, and will also determine infection in a fetus.

Infection with syphilis before pregnancy: what to do?

When the syphilis before pregnancy, when a course of treatment, the risk of transmission of Treponema infection and the fruit is progressively reduced. It will be the lower, the longer was the period of illness prior to conception. According to doctors after 2-3 years the risks to the fetus are minimal as at that time achieved a complete cure of syphilis. If the pregnancy before this time, the results of blood tests from pregnant to prevent congenital infection in the fetus, the doctor may prescribe the woman of preventive therapy.

Therapy is conducted during the period 20-24-th weeks of pregnancy is the time when the placenta has already been formed in the treatment at this time would be most valuable. The child will receive the necessary amount of drugs through the placenta. During pregnancy a woman is already not contagious and not dangerous to others, and she can give birth in any maternity hospital of her choice. At the same time it should be all documents with the confirmation of the diagnosis and pursued the full course of treatment.

A typical situation for syphilis during pregnancy

There are a few typical situations, in the presence of identified syphilis in women before pregnancy.

Tactics for the mother and fetus when they are slightly different:

• If the infection was relatively recently, but before pregnancy, and the woman received a full course of treatment, her tests are still positive and it was not removed from the register for this infection. During pregnancy it is tests every trimester, but research has more than in healthy women. In the period 20-24 weeks a prophylactic treatment to protect the fetus. After birth a baby must examine to syphilitic infection.
• if the woman was infected long ago, and now remained positive non-treponemal tests (an indicator of treated early syphilis), pregnancy check tests for infection once a trimester. In the period 20-24-th weeks of pregnancy to the woman carry out preventive therapy. In these cases, the recommended additional planning and preliminary treatment of syphilis, and after the birth of the crumbs and it will be necessary examine for syphilis.
• if the infection is long-standing, currently during pregnancy non-treponemal tests show negative results during pregnancy, repeat them at least 3-4 times. If all the tests are negative, no treatment to pursue is not necessary. If at least one of the tests will be positive to prevent infection in the baby carried out a preventive course of therapy. After the birth, then the child should be screened for syphilis.

All case of doubt decide in favor of treatment and benefits to the fetus.

Diagnosis of syphilis in a child: the exclusion of intrauterine infection

If congenital syphilis is suspected, it is necessary to conduct a range of surveys of the child. It is important to study the General information about the mother and her health condition, the duration of infection for her own and held courses of treatment.

On the basis of the received information, the doctor selects the tactics in the examination of the newborn, based on certain options:

• pregnant not been treated or have not finished the therapy before the end ofthe survey to identify the signs of congenital infection. If they are detected, immediately proceed to the treatment. Conducted all kinds of tests, taking blood within 7-10 days from the moment of birth. According to testimony carried also the sampling of the CSF to diagnose neurosyphilis. After analyzing all the obtained data the child is given oral medication.
• pregnant been treated for syphilis, seen a doctor, received all the treatment. The baby will be examined by an otolaryngologist, a neurologist, an ophthalmologist and will be carried out x-ray the bones. If the identified at least one symptom of congenital syphilis, diagnosis is shown as an adult.

Until one year of age the child is on the account from the experts as threatened by the manifestation of intrauterine infection. It is often and precisely, will be examined by the experts, noting the dynamics in its development and possible signs of the disease. At the age of three months screening for infectious lesions, the child is examined by specialists, tests for syphilis. If identified positive test results, apply the treatment of syphilis, if defined only the outward signs – check again in 3 months. Negative tests – even one survey per year. If no signs of infection, the child is removed from the register for congenital syphilis if the signs are still present, monitoring is carried out and then, if necessary, prescribing medication.