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Chapter 8 : Syphilis and Pregnancy

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Abstract:

Untreated syphilis during pregnancy is associated with spontaneous abortion, stillbirth, nonimmune hydrops, premature delivery, and perinatal death. Syphilis in the United States is currently found among racial and ethnic minorities who live in poverty. A major contributor to the increased incidence of syphilis in the late 1980s and early 1990s was the use of crack cocaine and the exchange of illegal drugs for sex. Gestational syphilis primarily affects women who are young and unmarried and who receive inadequate or no prenatal care. A pregnant woman with syphilis can transmit the infection to her unborn infant in utero, presumably by a transplacental route or possibly during delivery by contact with a genital lesion. The effect of concurrent maternal infection with and HIV on the risk of fetal infection with and HIV remains to be elucidated. The risk of prematurity, perinatal death, and congenital infection is directly related to the stage of maternal syphilis during pregnancy. An early clue to the diagnosis of congenital syphilis is provided by examination of the placenta. The infected placenta is often large, thick, and pale; the histologic findings consist of focal villitis, endovascular and perivascular proliferation in villous vessels, and relative immaturity of the villi. Penicillin remains the drug of choice for treatment of both acquired and congenital syphilis. Prevention of syphilis among pregnant women has remained an elusive public health goal.

Citation: Sánchez P. 1999. Syphilis and Pregnancy, p 125-150. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch8
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Figure 1

Reported cases of primary and secondary syphilis per 100,000 population in the United States, 1996 ( ).

Citation: Sánchez P. 1999. Syphilis and Pregnancy, p 125-150. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch8
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Image of Figure 2
Figure 2

Reported cases of primary and secondary syphilis per 100,000 population by race and ethnicity in the United States, 1981 to 1996 ( ).

Citation: Sánchez P. 1999. Syphilis and Pregnancy, p 125-150. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch8
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Figure 3

Congenital syphilis cases in infants younger than 1 year of age, 1970 to 1997 ( ). P & S, primary and secondary syphilis among women. Note: the surveillance case definition for congenital syphilis changed in 1988.

Citation: Sánchez P. 1999. Syphilis and Pregnancy, p 125-150. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch8
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Figure 4

Algorithm for management of infants born to mothers with reactive serologic tests for syphilis.

Citation: Sánchez P. 1999. Syphilis and Pregnancy, p 125-150. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch8
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Tables

Generic image for table
Table 1

Surveillance case definition for congenital syphilis

Citation: Sánchez P. 1999. Syphilis and Pregnancy, p 125-150. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch8
Generic image for table
Table 2

Syphilis in pregnancy: outcome by stage of infection

Citation: Sánchez P. 1999. Syphilis and Pregnancy, p 125-150. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch8
Generic image for table
Table 3

Clinical findings and their frequencies in infants with early congenital syphilis

Citation: Sánchez P. 1999. Syphilis and Pregnancy, p 125-150. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch8
Generic image for table
Table 4

Clinical findings in late congenital syphilis

Citation: Sánchez P. 1999. Syphilis and Pregnancy, p 125-150. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch8
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Table 5

Treatment guidelines for acquired syphilis during pregnancy

Citation: Sánchez P. 1999. Syphilis and Pregnancy, p 125-150. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch8

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