Syphilis in newborns. Symptoms, signs and treatment of congenital syphilis

• What is congenital syphilis
• Symptoms of congenital syphilis
• Treatment of congenital syphilis
• Which Doctors Should You See If You Have Congenital Syphilis

What is congenital syphilis

TO early congenital syphilis include fetal syphilis, infancy syphilis and early syphilis childhood.

Late congenital syphilis usually comes to light after 15-16 years, and until then does not manifest itself in any way. However, sometimes the symptoms of late congenital syphilis appear starting from the third year of life.

What Causes Congenital Syphilis

congenital syphilis develops when pale treponema enters the fetus through the umbilical vein or through the lymphatic clefts from a mother with syphilis. The fetus can become infected in case of illness of the mother before pregnancy, as well as at different stages of its development. Pathological changes in the organs and tissues of the fetus develop in the V-VI months of pregnancy, i.e. during the development of placental circulation.

Pathogenesis (what happens?) during congenital syphilis

According to a number of scientists, a syphilitic infection can also affect the chromosomal apparatus of the germ cells of the parents. There are syphilitic gametopathies (degenerative changes that occurred in germ cells before fertilization), blastopathies (damage to the embryo during blastogenesis) and syphilitic embryopathies ( pathological changes fetus in the period from 4 weeks. up to 4-5 months pregnancy). In such sick children, a variety of defects of a physical, neurological and mental, intellectual nature are found.
Congenital syphilis occurs when Treponema pallidum enters the fetus through the placenta from a mother with syphilis. Infection of the fetus can occur both in the case of maternal illness before conception, and later, at different stages of fetal development. Pale treponemas enter the fetus through the umbilical vein or through the lymphatic clefts of the umbilical vessels. Despite the early penetration of pale treponema into the fetal body, pathological changes in its organs and tissues develop only in the 5th-6th months of pregnancy. Therefore, active antisyphilitic treatment in early pregnancy can ensure the birth of healthy offspring. Since secondary syphilis occurs with symptoms of spirochetemia, the risk of having a sick child in pregnant women with secondary syphilis is greatest. In addition, the transmission of syphilis to offspring occurs mainly in the first years after infection of the mother; later this ability gradually weakens. Counts possible birth children with syphilis from a mother suffering from congenital syphilis (second and even third generation syphilis). However, such cases are very rare. The outcome of pregnancy in a woman with syphilis is different: it can end in a late miscarriage, premature birth, the birth of sick children with early or late manifestations disease or latent infection. Women with syphilis are characterized by a different pregnancy outcome for various stages the course of the process, since the degree of infection of the fetus depends on the activity of the infection. The possibility of infection of the fetus by transmission of the infection through the sperm from the father has not yet been proven.

Symptoms of congenital syphilis

Depending on the clinical symptoms, the characteristics of the course of the disease and the timing of its manifestation, congenital syphilis is divided into fetal syphilis, early congenital syphilis (from birth to 4 years), late congenital syphilis (in children older than 4 years), latent congenital syphilis observed during all age groups.

Classification of congenital syphilis
Traditional classification of congenital syphilis:
1. Fetal syphilis.
2. Syphilis in infants (up to 1 year).
3. Syphilis of early childhood (from 1 year to 4 years).
4. Late congenital syphilis (from 4 years and older).
5. Hidden congenital syphilis (occurs in infants and aged 1 year and older).

According to the international classification adopted by the XXIX World Health Assembly, congenital syphilis is divided as follows:
- early congenital syphilis with symptoms in children under 2 years of age;
- latent early congenital syphilis (no clinical manifestations, positive serological reactions, cerebrospinal fluid without pathology) in children under 2 years of age;
- early congenital syphilis, unspecified.

According to the international statistical classification of diseases, there are:
- early congenital syphilis (infection period up to 2 years);
- late congenital syphilis with a disease duration of more than 2 years from birth;
- unspecified congenital syphilis.

Early congenital syphilis (infection period up to 2 years):
1. Early congenital syphilis with symptoms(any congenital syphilitic condition, both early and manifested before the age of 2 years):
- early congenital syphilis of the skin;
- early congenital syphilis of the skin and mucous membranes;
- early congenital syphilis visceral;
- early congenital syphilitic laryngitis;
- early congenital syphilitic ophthalmopathy;
- early congenital syphilitic osteochondropathy;
- early congenital syphilitic pharyngitis;
- early congenital syphilitic pneumonia;
- early congenital syphilitic rhinitis.
2. Early congenital syphilis latent(congenital syphilis without clinical manifestations with a positive serological reaction and a negative test of cerebrospinal fluid in children under the age of 2 years).
3. Early congenital syphilis, unspecified(congenital syphilis without bacteriological or histological confirmation in a child under 2 years of age; i.e., the diagnosis is established in the absence of a full examination of the child or if the clinical picture of the examination does not make it possible to judge the degree of specificity of the existing pathology).

Syphilis of the placenta
The placenta affected by syphilis is enlarged, hypertrophied, flabby, fragile, easily torn, heavy. Its mass is 1/4-1/3 of the mass of the fetus (normally 1/6-1/5). According to statistics, on average, up to 50% of cases of severe placenta are associated with congenital syphilis. To confirm the diagnosis of placental syphilis, a histological examination is necessary. With a syphilitic lesion in the germinal part of the placenta, edema, proliferation of granulation cells, damage to the central part of the villi (abscesses) and blood vessels (mainly peri- and endoarteritis) are detected, pale treponemas are detected. Histological changes in the maternal part of the placenta are rare, they are less pronounced and do not have a specific character. Pale treponemas are rarely found, which is explained by intensive processes of phagocytosis. Specific septicemia and pale treponema are determined in various organs of the fetus (liver, spleen, adrenal glands), umbilical cord, less often in the blood and placenta. More permanent are changes in the umbilical cord, which are manifested by leukocyte infiltration of the walls of blood vessels, especially the muscle layer (endo-, meso-, perivasculitis), with predominant localization in the umbilical vein. Often there is a change in the amount of amniotic fluid (more often a decrease), which leads to a disruption in the development of individual organs and systems, in particular nervous system.

A reliable sign of syphilis is the presence of pale treponema in the umbilical cord, where they are found in large numbers in almost all cases of congenital syphilis, and in the placenta.

If syphilis is suspected in a woman in labor, it is necessary to conduct a microscopic examination of the fetal end of the umbilical cord for pale treponema in dark field vision. If this is difficult in the maternity hospital, it is necessary to cut off the peripheral end of the umbilical cord 5 cm long from the fetal end, place it in a sterile tube and send it to the laboratory for examination for pale treponema. Women with untreated syphilis are characterized by late miscarriages, cases of stillbirth (fetus with signs of maceration) in the VI-VII months of pregnancy. Often, with fetal syphilis, no specific changes are found in the placenta, which is explained by the effect of antisyphilitic treatment or infection of a woman with syphilis during pregnancy. At the birth of a child with clinical symptoms of syphilis, pale treponemas are quite often found in the fetal and maternal parts of the placenta, even in the absence of visible manifestations of syphilis in the mother.

Fetal syphilis
As a result of the defeat of the syphilitic infection of the placenta, the nutrition of the fetus, metabolism are disturbed and intrauterine death occurs, followed by miscarriage of the fetus. In the first months of pregnancy, pale treponemas in the fetus may not be detected, as they penetrate into his body with the development of placental circulation.

Starting from the 5th month of pregnancy, miscarriages, premature births and stillbirths show signs characteristic of syphilis:
- the fetus has a small size, low body weight; signs of maceration;
- in the lungs, liver, kidneys, spleen and endocrine glands, specific lesions are detected, manifested by diffuse small cell infiltration, proliferation of connective tissue, changes in the walls of blood vessels;
- in the tissues of internal organs, pale treponemas are found in large numbers.

Lungs. A typical lesion of the lungs (“white pneumonia”, “pneumonia alba”) is also characteristic - focal or diffuse specific infiltration of the interalveolar septa, hyperplasia and desquamation of the alveolar epithelium, fatty degeneration and filling of the alveoli with it. Lung tissue is airless, grayish-white.

Liver. Enlarged, dense, with a smooth surface. Small cell infiltration and small foci of necrosis are found yellowish color often develops organ atrophy. On the section, the liver tissue is dull, yellow-brown, pronounced sclerotic changes are noted.

Spleen. Usually enlarged, compacted.

Kidneys. The cortical layer is most often affected. Underdeveloped glomeruli and tubules, cysts, diffuse small cell infiltration are revealed.

Digestive tract. In the mucous and submucosal layer of the stomach and intestines (usually thin), flat infiltrates, ulcerated in places, are noted.

Heart. Rarely affected. Foci of cell infiltration, swelling of cells around the vessels, necrotic areas are revealed.

Endocrine glands. The adrenal glands are more often involved in the pathological process, then the pancreas, the pituitary gland, and the sex glands. There is focal or significant diffuse infiltration with areas of necrosis.

Central nervous system. Inflammatory changes are revealed, which are manifested by productive leptomeningitis with vascular sclerosis, meningoencephalitis, granular ependymatitis. Quite often gummas of a medulla oblongata develop.

The most frequent and reliable sign of fetal syphilis is the detection during X-ray examination at V-VI months prenatal development specific osteochondritis I, II, III degree or osteoperiostitis with predominant localization at the ends of long tubular bones in the growth zone (on the border between the diaphysis and the epiphysis).

Congenital syphilis of infants (syphilis congenita praecox).
Many organs and systems are involved in the pathological process, which leads to a variety of symptoms.

Characteristic appearance child:
- “senile”, dry, wrinkled face;
- the head is large, with developed frontal tubercles and an abundant venous network, often covered with seborrheic crusts;
- sunken bridge of nose;
- areas of pigmentation are often noted on the face;
- the skin is pale, flabby, dirty yellow;
- limbs are thin, cyanotic;
- the child is restless, cries continuously, sleeps anxiously, often at night or with sudden movements emits a piercing cry, which is associated with damage to the central nervous system;
- the child develops poorly, quickly loses weight;
- persistent runny nose (difficulty breathing and sucking) is detected;
- there are phenomena of dystrophy with practically total absence subcutaneous adipose tissue (decubitus may form).
Often (up to 70% of cases) skin lesions are observed.

Pemphigus syphilis (pemphigus syphiliticus)
Syphilitic pemphigus is one of the reliable signs of syphilis, existing already at the birth of a child or appearing in the first days of his life.

Syphilitic pemphigus is characterized by the following clinical symptoms:
- blisters are located mainly on the palms and soles, as well as on the face, flexor surfaces of the forearms and shins, less often all over the skin;
- the size of the bubbles - from a pea to a cherry;
- bubbles usually do not merge;
- the tire of bubbles is dense;
- the base of the bubble is hyperemic, infiltrated;
- the contents are serous or serous-purulent, less often hemorrhagic;
- a large number of pale treponemas are found in the contents;
- after the opening of the blisters, red infiltrated erosions are formed, the discharge from the surface of which subsequently dries up, and brownish crusts form;
- often before the appearance of blisters, spotted and papular rashes appear.

In the absence of antisyphilitic treatment, children die.

Congenital syphilis of early childhood, syphilis of early childhood (from 1 year to 4 years) (syphilis congenita praecox)
Usually, only individual organs and systems are involved in the pathological process. Mild clinical symptoms are characteristic, as in secondary recurrent syphilis. Limited large papules appear on the skin in the genital area, anus, inguinal folds, interdigital folds of the feet, often weeping, vegetating. They may coalesce to form broad warts that erode or ulcerate. In weakened children, papules and pustules may appear on the scalp and face. Roseolous rashes are rare. Localized on the mucous membranes of the mouth, tongue, pharynx, tonsils, gums, papular rashes take the form of eroded opal nodules. Due to constant maceration in the corners of the mouth, they resemble banal jams. When nodules appear on the mucous membrane of the larynx, papular rashes merge and form a diffuse papular infiltration, which is clinically manifested by a hoarse, hoarse voice, aphonia, and sometimes stenosis of the larynx. Sometimes there is syphilitic rhinitis, causing atrophic catarrh and often perforation of the nasal septum. Diffuse or focal specific alopecia may be observed. Slightly enlarged lymph nodes, often ulnar on both sides. Gummas rarely occur. In 60% of children, damage to the skeletal system is characterized by limited periostitis, osteoperiostitis, and osteosclerosis phenomena with frequent localization in the area of ​​long tubular bones, which is detected only by X-ray examination. Diffuse periostitis of the fingers, metacarpal bones (bottle-shaped phalangitis) is often noted. Much less often bone gummas are formed. Sometimes there is an increase and thickening of the liver, spleen, the phenomenon of nephronephritis. Often the testicles are affected, which increase, become dense, bumpy. Damage to the nervous system is manifested by mental retardation, epileptiform seizures, hydrocephalus, hemiplegia, meningitis. Rarely, tabes can begin. Possible eye damage (choreoritinitis, optic nerve atrophy, parenchymal keratitis). Standard serological tests in most children are positive.

Late congenital syphilis (syphilis congenita tarda)
Clinical symptoms occur not earlier than 4-5 years of age, can be observed in the 3rd year of life, but more often - at 14-15 years, and sometimes later. In most children, early congenital syphilis is asymptomatic (early latent congenital syphilis) or even early latent syphilis may be absent, others show changes characteristic of early congenital syphilis (saddle nose, Robinson-Fournier scars, skull deformity). With late congenital syphilis, tubercles, gummas appear on the skin and mucous membranes, numerous visceropathy, diseases of the central nervous system, and endocrine glands are noted. The clinical picture of late congenital syphilis does not differ from that of the tertiary period of syphilis. Diffuse hardening of the liver is noted. Gummatous nodes may appear much less frequently. Possible damage to the spleen, as well as nephrosis, nephronephritis. When involved in the pathological process of cardio-vascular system valvular insufficiency, endocarditis, myocarditis are detected. There is evidence of lung injury, digestive tract. Typical is the defeat of the endocrine system (thyroid gland, adrenal glands, pancreas and gonads).

The characteristic features of the clinical picture of late congenital syphilis are specific symptoms, which are divided into unconditional (reliably indicate congenital syphilis) and probable (require additional confirmation of the diagnosis of congenital syphilis). There is also a group of dystrophic changes, the presence of which does not confirm the diagnosis of syphilis, but which should be excluded.

Unconditional symptoms
Parenchymal keratitis (keratitis parenchymatosa). As a rule, one eye is initially involved in the pathological process, after 6-10 months - the second. Regardless of treatment, there are signs of parenchymal keratitis (diffuse corneal opacity, photophobia, lacrimation, blepharospasm). Clouding of the cornea is more intense in the center and often develops not diffusely, but in separate areas. The corneal and conjunctival vessels were dilated. Visual acuity decreases and often disappears. At the same time, other eye lesions can be observed: iritis, chorioretinitis, optic nerve atrophy. The prognosis for the restoration of vision is unfavorable. Almost 30% of patients have a significant decrease in visual acuity.

Dental dystrophies, Getchinson's teeth (dentes Hutchinson). First described by Getchinson in 1858 and are manifested by hypoplasia of the chewing surface of the upper middle permanent incisors, along the free edge of which semilunar, crescent-shaped notches are formed. The neck of the tooth becomes wider (“barrel-shaped” teeth or in the form of a “screwdriver”). There is no enamel on the cutting edge.

Specific labyrinthitis, labyrinth deafness (surditas labyrinthicus). It is observed in 3-6% of patients aged 5 to 15 years (more often in girls). Due to inflammation, hemorrhages in the inner ear, degenerative changes in the auditory nerve, deafness suddenly occurs due to damage to both nerves. In the case of development up to 4 years of age, it is combined with difficulty in speech, up to dumbness. Bone conduction is impaired. It is resistant to specific therapy.

It should be noted that all three reliable symptoms of late congenital syphilis - the Getchinson triad - are quite rare at the same time.

Likely Symptoms
They are taken into account in the diagnosis, subject to the identification of other specific manifestations, anamnesis data and the results of an examination of the patient's family.

specific drives, first described by Cletton in 1886, occurs in the form of chronic synovitis of the knee joints. The clinical picture of the defeat of the cartilage of the epiphyses is absent. On examination, an increase in the joint, its swelling, limited mobility, and painlessness are noted. Perhaps symmetrical damage to another joint. Often, the elbow and ankle joints are involved in the pathological process.

Bones are often affected with a predominance of hyperplastic processes in the form of osteoperiostitis and periostitis, as well as gummy osteomyelitis, osteosclerosis. Destruction of a bone in combination with processes of a hyperplasia is characteristic. Due to inflammation, increased bone growth occurs. Quite often, a symmetrical lesion of long tubular bones, mainly tibia, is noted: under the weight of the child, the tibia bends forward; “saber-shaped shins” (tibia syphilitica) develop, which is diagnosed as a consequence of syphilitic osteochondritis transferred in infancy. As a result of the transferred syphilitic rhinitis, underdevelopment of the bone or cartilaginous parts of the nose is noted, characteristic deformations of the organ occur.

saddle nose observed in 15-20% of patients with late VS. Due to the destruction of the nasal bones and the nasal septum, the nostrils protrude forward.

Goat and lornet nose is formed as a result of small cell diffuse infiltration and atrophy of the nasal mucosa, cartilage.

Buttock-shaped skull. The frontal tubercles stand as if separated by a furrow, which occurs due to syphilitic hydrocephalus and osteoperiostitis of the skull bones.

Dystrophic lesions of the teeth. On the first molar, atrophy of the contact part and underdevelopment of the chewing surface are noted. The shape of the tooth resembles a pouch (moon tooth). The chewing surface can also be changed on the 2nd and 3rd molars (Moser and Pfluger teeth). Instead of a normal chewing tubercle, a thin conical process (Fournier's pike tooth) forms on the surface of the canine.

Robinson-Fournier radial scars. Around the corners of the mouth, lips, on the chin are radial scars, which are the result of congenital syphilis transferred in infancy or early childhood - Gochsinger's diffuse papular infiltration.

Damage to the nervous system observed often and manifested by mental retardation, speech disorder, hemiplegia, hemiparesis, dorsal tabes, Jacksonian epilepsy (convulsive twitching of one half of the face or limb due to gumma or limited meningitis).

specific retinitis. The choroid, retina, optic nerve papilla are affected. On the fundus is revealed typical picture small pigmented foci in the form of "salt and pepper".

Dystrophies (stigmas) sometimes indicate congenital syphilis. May be a manifestation of syphilitic lesions of the endocrine, cardiovascular and nervous systems:
- high ("lancet" or "Gothic") hard palate;
- dystrophic changes in the bones of the skull: protruding frontal and parietal tubercles, but without a dividing groove;
- additional tubercle of Carabelli: an additional tubercle appears on the inner and lateral surface of the upper molars;
- absence of the xiphoid process of the sternum (axifoidia);
- infantile little finger (Dubois-Hissar symptom) or shortening of the little finger (Dubois symptom);
Widely spaced upper incisors (Gachet symptom).
- thickening of the sternoclavicular joint (symptom of Avsitidia);
Hypertrichia can be observed in both girls and boys. Often there is an overgrowth of the forehead with hair.

Diagnosis of congenital syphilis

It should be noted that only a few dystrophies (stigmas) can be of diagnostic value and only in combination with reliable signs of syphilis. In establishing the diagnosis, standard serological tests, which are defined as "positive" in early congenital syphilis, can be of invaluable help. In late congenital syphilis, complex serological reactions (CSR) are defined as "positive" in 92%, and immunofluorescence reactions (RIF), pale treponema immobilization reaction (RIBT) - in all patients. An examination of the cerebrospinal fluid, radiography of the osteoarticular apparatus, consultation and examination by a pediatrician, ophthalmologist, otolaryngologist, neuropathologist and other specialists are of great diagnostic importance.

When conducting a differential diagnosis of early latent congenital syphilis and passive transmission of antibodies, quantitative reactions are of great importance. Antibody titers in a sick child should be higher than in the mother. In healthy children, antibody titers decrease and spontaneous negative serological reactions occur within 4-5 months. In the presence of infection, antibody titers are persistent or their increase is observed. In the first days of a child's life, serological tests may be negative despite the presence of syphilis, so they are not recommended in the first 10 days after the birth of a child.

If congenital syphilis is suspected, diagnostic tactics must be followed, which is as follows:
- conduct a one-time examination of the mother and child;
- it is not recommended to take blood for serological examination in a woman 10-15 days before and earlier than 10-15 days after childbirth;
- it is not advisable to take blood for serological examination from the umbilical cord of a child in the first 10 days after birth, since protein lability, instability of serum colloids, lack of complement and natural hemolysis, etc. are observed during this period;
- in the serological examination of the mother and child, it is necessary to use a complex of serological reactions (Wasserman reaction, RIF, RIBT);
- it should also be remembered that positive serological reactions in a child may be due to the passive transfer of antibodies from the mother, but gradually, within 4-6 months after birth, the antibodies disappear and the test results become negative.

Treatment of congenital syphilis

Pale treponema is actually the only microorganism that has retained to date, despite decades of penicillin therapy, a unique high sensitivity to penicillin and its derivatives. It does not produce penicillinases and does not have other mechanisms of antipenicillin protection (such as mutations in cell wall proteins or the polyvalent drug resistance gene) that have long been developed by other microorganisms. Therefore, even today the main method of modern antisyphilitic therapy is the long-term systematic administration of penicillin derivatives in sufficient doses.
And only if the patient is allergic to penicillin derivatives or if the strain of pale treponema isolated from the patient is confirmed to be resistant to penicillin derivatives, can an alternative treatment regimen be recommended - erythromycin (other macrolides are probably also active, but their effectiveness is not documented by the instructions of the Ministry of Health, and therefore they not recommended), or tetracycline derivatives, or cephalosporins. Aminoglycosides suppress the reproduction of pale treponema only in very high doses that have a toxic effect on the host organism, therefore the use of aminoglycosides as monotherapy for syphilis is not recommended. Sulfonamides are generally not effective for syphilis.

In neurosyphilis, a combination of oral or intramuscular administration of antibacterial drugs with their endolumbar administration and with pyrotherapy, which increases the permeability of the blood-brain barrier for antibiotics, is mandatory.

With widespread tertiary syphilis against the background of pronounced resistance of pale treponema to antibacterial drugs and with a good general condition of the patient, allowing for a certain toxicity of the therapy, it may be recommended to add bismuth derivatives (biyoquinol) or arsenic derivatives (miarsenol, novarsenol) to antibiotics. Currently, these drugs are not available in the general pharmacy network and are only available in specialized institutions in limited quantities, as they are highly toxic and rarely used.

With syphilis, it is imperative to treat all the patient's sexual partners. In the case of patients with primary syphilis, all persons who have had sexual contact with the patient within the last 3 months are treated. In the case of secondary syphilis, all persons who had sexual contact with the patient during the last year.

Forecast disease is mainly determined by the rational treatment of the mother and the severity of the disease of the child. Usually, early start treatment, good nutrition, careful care, feeding breast milk contribute to favorable outcomes. The timing of the start of treatment is of great importance, since specific therapy started after 6 months is less effective.
In recent years, in infants with congenital syphilis, due to a full course of treatment, standard serological reactions become negative by the end of the 1st year of life, with late congenital syphilis - much later, and RIF, RIBT can remain positive for a long time.

Prevention of congenital syphilis

The system of dispensary services for the population (mandatory registration of all patients with syphilis, identification and treatment of sources of infection, free high-quality treatment, preventive examinations of pregnant women, employees of child care facilities, food enterprises, etc.) led to a sharp decrease in cases of registration of congenital forms of syphilitic infection by the end of the 80s . However, in the context of the epidemic increase in the incidence of syphilis, noted in the 90s, there was a sharp jump in the number of registered cases of congenital syphilis. Control over the situation is facilitated by the constant connection of women's and children's clinics and maternity hospitals with skin and venereal dispensaries. According to the instructions existing in our country, antenatal clinics register all pregnant women and subject them to clinical and serological examination. Serological examination for syphilis is carried out twice - in the first and second halves of pregnancy. If an active or latent form of syphilis is detected in a pregnant woman, treatment is prescribed only with antibiotics. If a woman had syphilis in the past and completed anti-syphilitic treatment, then during pregnancy, a specific drug is still prescribed. preventive treatment to ensure the birth healthy child. For 1-2 weeks. before delivery, non-specific false-positive serological reactions may occur. In this case, the pregnant woman is not subjected to specific treatment, and after 2 weeks. after childbirth, the examination of the mother is repeated and the child is carefully examined. When the diagnosis of syphilis is confirmed in the mother and child, they are prescribed anti-syphilitic treatment. Newborns, mothers who were insufficiently treated in the past and who for some reason could not receive preventive treatment during pregnancy, are examined to determine the form and localization of the syphilitic infection, then treatment is prescribed according to the schemes approved by the Ministry of Health of Ukraine. And newborns whose mothers had syphilis and received full treatment before and during pregnancy are subjected to a thorough examination, followed by follow-up observation up to 15 years. 07/31/2018

In St. Petersburg, the AIDS Center, in partnership with the City Center for the Treatment of Hemophilia and with the support of the Society of Hemophilia Patients of St. Petersburg, launched a pilot information and diagnostic project for patients with hemophilia infected with hepatitis C.

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Syphilis (lues) is a sexually transmitted disease, usually chronic, of an infectious nature, characterized by systemicity. It is manifested by specific lesions of the skin, all mucous membranes, most bones, various internal organs, and most importantly, the nervous system. It is caused by a dangerous, very active bacterium, which received a sonorous name - pale treponema. Transmitted (most often) sexually, as well as through household items.

Especially dangerous congenital syphilis in children when dangerous infection transmitted to the child from a sick mother through the placenta. It can be diagnosed at different ages, and therefore there are several types of the disease.

The classification of congenital syphilis detected in children is based on the age at which this disease manifests itself. The range is quite wide: from chest to adolescence life.

For further prognosis, the time of manifestation of specific lesions is of great importance: the earlier the symptoms are detected, the more favorable it is. Doctors diagnose the following forms of the disease.

early congenital syphilis

• Fetal syphilis

Most often, doctors diagnose early congenital syphilis of the fetus when it occurs intrauterine infection. If this happened at 5-6 months, they may begin. The baby is usually born dead, macerated (flabby, swollen, loose body), with pathologies of the lungs, spleen, liver.

• syphilis of infancy

If the infection of the mother occurred on later dates pregnancy, the symptoms of the disease appear after the birth of the baby. When diagnosing syphilis in infancy, the Wasserman reaction is detected only at the 3rd month of a newborn's life.

• Syphilis in early childhood

This form of the disease is said if it manifested itself between the ages of 1 and 4 years.

late congenital syphilis

In most cases, late congenital syphilis manifests itself and is diagnosed in children in adolescence, without revealing itself before. This is a dangerous recurrence of a disease suffered in early childhood - not detected or insufficiently treated in time.

Latent congenital syphilis

This form of the disease can be observed in a child at any age. Its complexity is that it usually proceeds in the absence of symptoms. Therefore, latent congenital syphilis can only be detected as a result of serological studies (carried out on the basis of biological material, most often cerebrospinal fluid).

All these forms of congenital syphilis do not pass without a trace. Among the most dangerous consequences are disability and mortality. The symptomatology of a latent disease allows the child to live up to a certain point, and he will not differ in any way from his peers in his development. However, you need to understand that someday the infection will still manifest itself.

through the pages of history. Syphilis was named in 1530 by an Italian poet and doctor named Girolamo Fracastoro.

Causes of the disease

Pale treponema infects the fetus, penetrating to it into the placenta through the lymphatic slits of the vessels or the umbilical vein. It is transmitted to a child from a mother with syphilis. Children are at risk if:

• the infection of the woman occurred before conception;
• infection was diagnosed at different stages of pregnancy;
• the mother is ill with secondary or congenital syphilis.

The transmission of bacteria from mother to child occurs in the first years of her infection, when the stage of the disease is active. With the passage of age, this ability gradually weakens.

If a woman suffers from chronic form, but at the same time it is constantly being treated, it is quite possible for her to have a healthy baby. Therefore, it is necessary to constantly undergo special examinations and carefully monitor the condition of the fetus during its intrauterine development, and then - for its health in the future, in order to detect even a latent form of the disease in time. To do this, you need to know the clinical picture of the course of the infection, i.e., its symptoms.

Keep in mind! The transmission of the infection to the fetus from the sperm has not been scientifically proven, so there is no point in blaming the father of the child for congenital syphilis.

Symptoms

Since there are still chances for a healthy baby to appear if the mother is infected, it is necessary to identify signs of congenital syphilis in time even at the stage of intrauterine development of the fetus. This will allow you to take the necessary measures, find out the degree of infection activity and make at least some forecasts for the future. The symptomatology of the disease is very diverse and largely depends on the stage at which it was detected, that is, on its form.

Symptoms of congenital syphilis of the fetus

• Large size of the fetus;
• small body weight;
• maceration (swelling, friability);
• enlarged liver, its atrophy;
• enlarged, compacted spleen;
• underdeveloped kidneys, covered with a crust;
• stomach ulcers;
• damage to the central nervous system, brain.

Symptoms of congenital syphilis of infancy

• Dry, wrinkled face;
• a large head with strongly developed tubercles on the forehead, a pronounced venous network, seborrheic crusts;
• pigmentation on the face;
• sunken nose bridge;
• pale, dirty yellow, flabby skin;
• thin, cyanotic limbs;
• the child is restless, constantly crying, sleeping poorly, screaming piercingly;
• poor development;
• weight loss;
• persistent runny nose, which causes difficulty in breathing and sucking;
• with a complete absence of fatty subcutaneous tissue;
• over time, bedsores form;
• syphilitic pemphigus on the palms, soles, face, elbows, knees: large vesicles with purulent contents;
• epidemic pemphigus are large blisters merging with each other, bleeding, eroded, accompanied by high temperature, diarrhea, green stools;
• diffuse thickening of the skin - scaly erosion on the palms, face, soles, head, accompanied by loss of hair and eyebrows, swelling of the lips, cracks in the corners of the mouth, crusts on the chin, ulcers on the entire surface of the body;
• erysipelas;
• redness of the heels;
• papular syphilide - the formation of copper-red papules and age spots;
• roseola rash - individual scaly brownish spots that tend to merge;
• syphilitic alopecia - loss of hair, eyelashes, eyebrows;
• syphilitic rhinitis - hypertrophy of the mucous membrane of the nose, mouth, larynx;
• Wegner's syphilitic osteochondritis is a pathological lesion of the skeletal system, which often leads to a false paralysis-like condition, when the upper limbs hang with whips, the lower ones are constantly bent at the knees;
• damage to the joints in congenital syphilis in an infant is expressed by a movement disorder, complete immobility of the limbs;
• eye damage is sometimes the only sign of congenital syphilis: the fundus is pigmented, later - loss of vision, keratitis.

Symptoms of congenital syphilis at an early age

• The skin of the genitals, groin, anus, interdigital folds on the legs are affected by limited large weeping papules;
• roseolous rashes;
• seizures in the corners of the mouth;
• papules on the mucous membrane of the larynx merge, causing a hoarse, hoarse voice, aphonia, stenosis of the larynx;
• syphilitic rhinitis;
• baldness;
• swollen lymph nodes;
• periostitis, osteoperiostitis, osteosclerosis - a pathological lesion of the skeletal system;
• enlargement, hardening of the spleen and liver;
• nephrosonephritis (kidney dystrophy);
• enlargement, hardening of the testicles;
• as a result of damage to the nervous system, mental retardation is often diagnosed with congenital syphilis, as well as epileptiform seizures, hemiplegia (paralysis of one part of the body),;
• eye damage: chorioritinitis, optic nerve atrophy, keratitis.

Symptoms of late congenital syphilis

1. Reliable signs

• Keratitis is a pathological inflammation of the cornea of ​​​​the eye, which is accompanied by clouding of the mucous membrane in separate areas, photophobia, lacrimation, blepharospasm, decreased visual acuity, atrophy of the optic nerve up to complete blindness;
• dental dystrophies;
• specific labyrinthitis - deafness, combined with difficulty in speech, dumbness may occur.

1. Likely signs

• Specific drives - damage to the knee joints, which increase, swell, hurt;
• bone damage leads to the fact that the symptoms of late congenital syphilis are visible to the naked eye: the shins become saber-shaped, and the child's gait changes greatly;
• saddle nose;
• buttock-shaped skull;
• dystrophy of teeth;
• radial scars, which are called Robinson-Fournier, near the mouth, chin;
• due to a serious lesion of the central nervous system, oligophrenia is possible with congenital syphilis, as well as a speech disorder;
• specific retinitis;
• dystrophy (stigma).

The external manifestation of congenital syphilis in a child rarely goes unnoticed, unless it is a latent form of the disease. The damage to internal organs and systems is so powerful and extensive that already in infancy, the symptoms are noticeable even with the naked eye. They are difficult to confuse with signs of other diseases, especially since the infection of the baby is most often talked about during pregnancy.

It is especially important for parents to know how congenital syphilis manifests itself in adolescence (i.e. late), since at the beginning of the child’s life he did not find himself outwardly, while the harmful bacterium destroyed his tissues from the inside. Under laboratory conditions, the diagnosis is refuted or confirmed fairly quickly.

Important information. If the latent form of congenital syphilis is not cured in time, the matured child will be a living carrier of pale treponema, infecting other people with it.

Diagnostics

Since the disease in the mother is detected at any stage of pregnancy, a thorough diagnosis of congenital syphilis in the child is carried out while he is still in the womb. In the future, it represents all kinds of laboratory research.

1. X-ray. The disease is detected on an X-ray examination, which is performed at 5-6 months of pregnancy. It is recognized by specific osteochondritis (inflammation of the bones) or osteoperiostitis (inflammation of the periosteum).
2. Serological reactions of Wasserman, Kolmer, Kahn, Sachs-Vitebsky (KSR). They are based on the fact that an antigen is introduced into the child's blood, and then the body's reaction to it is studied.
3. The reaction of immobilization of bacteria that cause syphilis - pale treponema (RIBT).
4. Immunofluorescence reactions (RIF).
5. Study of the cerebrospinal fluid.
6. X-ray of the osteoarticular apparatus.
7. Examination of a child by such doctors as a pediatrician, neuropathologist, ophthalmologist, otolaryngologist.

All data based on the studies carried out are entered into the protocol for diagnosing congenital syphilis, according to which the disease is being treated. This medical document accompanies the child throughout his life, the results of tests and reactions are regularly entered into it, which are carried out constantly to monitor the patient's condition.

With proper care and a full course of treatment, which was carried out in a timely manner, the prognosis for a sick child can be quite favorable.

through the pages of history. August Wasserman - German microbiologist and immunologist of the late XIX - early XX century, created an express method for diagnosing syphilis.

Forecasts for the future

The prognosis for the future of a child with congenital syphilis can be very different. From the risk of dying in the womb to full recovery after birth. There are many concerns during and after pregnancy:

• late miscarriage;
• premature birth;
• pathology;
• the birth of a dead baby.

It is impossible to predict what will happen in one case or another. Different pregnancy outcomes depend on numerous factors: the stages of the process, the treatment that the mother has undergone or is still undergoing, the degree intrauterine infection fetus, infection activity and more.

Given the modern medical technologies that are used to treat congenital syphilis, with good nutrition, careful care for the baby, breastfeeding, you can hope for positive results and recovery.

The timing of the start of therapy is very important. In infants with this disease, standard serological reactions are restored by the first year of life. With late congenital syphilis, they become negative less frequently.

Treatment Methods

If the disease was detected in a timely manner, the treatment of congenital syphilis in infants gives positive results. The later the diagnosis was made, as well as with a latent form of infection, the consequences for the health and life of the child can be the most unfavorable, up to death. Treatment includes drug therapy and proper care.

Medical therapy

• Vitamin therapy;
• injections of penicillin and its derivatives (ecmonovocillin, bicillin);
• phenoxypenicillin;
• bismuth (if the child is more than six months old);
• if the child is allergic to penicillin - erythromycin, tetracycline, cephalosporins;
• a combination of muscle injection of antibacterial drugs with endolumbar injection (into the spine) and with pyrotherapy (artificial temperature increase);
• arsenic derivatives (miarsenol, novarsenol);
• immunomodulators;
• biogenic stimulants.

Care

• Regular hygiene procedures, since with such a disease, the skin of the child is primarily affected;
• breast-feeding;
• complete nutrition, which should include foods high in vitamins and proteins;
• daily regimen with meals at the same time, night sleep for at least 9 hours, as well as daytime sleep;
• daily walks or at least stay in the fresh air;
• regular spa specific treatment;
• constant monitoring and visits to the appropriate doctors.

If congenital syphilis of any form and stage is detected, the patient is placed in a venereal dispensary for therapy.

If a woman underwent appropriate treatment during pregnancy and the body of the newborn received all necessary procedures in the 1st month of his life, the disease does not pose a threat to later life child. If the diagnosis was made later, with latent forms and a late stage, therapy may not give results. In this case, the consequences may be the most undesirable.

Dangerous Consequences

The dangerous consequences of congenital syphilis for the further health of infected children will depend entirely on the timely course of treatment and the form of the disease. In most cases, they can still be avoided.

In the absence of specific timely therapy, the child may remain disabled for life or die due to the defeat of too many internal organs, systems and tissues by treponema.

Untreated, advanced congenital syphilis can lead to:

• mental and physical retardation;
• external deformities in the form of deformation of the skull, limbs, teeth, nose;
• dystrophy;
• dermatitis;
• baldness;
• loss of vision;
• deafness
• dumbness;
• paralysis;
• impotence in the future in boys and infertility in girls.

All these are symptoms of congenital syphilis, which, if not properly treated, progress and give rise to serious pathologies. As a result, irreversible processes lead to a child's disability for life.

Dangerous consequences, like the disease itself, can be easily avoided if preventive measures are taken in time.

Prevention

If the mother was infected before the 5th month of pregnancy, active and successful prevention of congenital syphilis is possible, since pathological metamorphoses of organs and tissues begin only at the 5th or 6th month. Therefore, fetal treatment early dates pregnancy leads to the birth of a healthy baby. If a woman has also undergone an appropriate course of therapy, the child is not in danger.

The modern level of medicine and early diagnosis of the disease make it possible to detect and treat congenital syphilis in a child in advance. This allows you to avoid dangerous consequences for the life and health of the baby in the future. An infected woman must also undergo a mandatory course of therapy and be under the close and constant supervision of doctors.

This diagnosis is not a sentence, it does not always end in death or disability, contrary to popular belief. Fight for your children - and even this disease will be defeated!

A mother's illness during pregnancy is dangerous for the unborn child. Syphilis in a newborn is the result of intrauterine infection.

The causative agent of the disease is Treponema pallidum (Treponema pallidum). Fetal infection occurs during pregnancy. The risk of infection is especially high if the expectant mother has early latent and secondary syphilis. If the patient did not receive treatment during pregnancy, in 20% of cases the fetus dies in utero. The probability of having a sick child is up to 95%.

Attention! Sometimes, fearing the condemnation of relatives, a young woman hides her illness and avoids treatment. The price of frivolous behavior is life and health!

Routes of infection

There are such ways:

1. Through the umbilical vein (in the form of an embolus).
2. The causative agent penetrates through the lymphatic slits of the vein and arteries of the umbilical cord.
3. Through the placenta. Toxins secreted by treponema cause damage to this organ, which negatively affects the development of the fetus. Trophic changes in the placenta lead to intrauterine hypoxia.

If during pregnancy there was chorionamnionitis, the risk of giving birth to a sick child after syphilis increases several times. A healthy placenta is a reliable barrier to the pathogen.

Important! Careful monitoring of the pregnant woman, treatment of concomitant diseases.

Symptoms of the disease

Sometimes appear immediately after birth:

1. The newborn looks like a little old man: wrinkled face, flabby skin hanging in folds.
2. The subcutaneous fat layer is thinned. Body weight is significantly below the norm for gestational age. The abdomen is enlarged. Color skin pale, with an earthy tint. On the abdomen and chest - venous network. characteristic view The child was named Habitus syphilitica.
3. If congenital syphilis after childbirth manifests itself in the first hours of life, the child is born in a serious condition. There is respiratory failure. In the general analysis of blood - anemia, thrombocytopenia.
4. Against the background of a decrease in the number of platelets, hemorrhagic syndrome develops, which manifests itself in the form of subcutaneous hemorrhages of various sizes.
5. On the part of the lungs - pneumonia, disseminated atelectasis, immaturity of the lung tissue.
6. Sometimes hepatitis develops. There is an increase in the level of bilirubin in the blood, especially due to the conjugated (direct) fraction. The skin of such children is painted dirty yellow. The liver is enlarged on palpation, bumpy and dense. In the absence of specific treatment, hepatitis leads to the gradual destruction of the liver.

A similar clinical picture can be with any congenital infection, which makes diagnosis difficult.

Syphilis in newborns can be hidden, without a characteristic clinical picture:

Photos and videos in this article will talk about the symptoms of the disease.

Examination plan for suspected congenital syphilis

The plan includes the following activities:

1. Detailed complete blood count. Anemia, leukocytosis, elevated ESR, and a shift of the neutrophilic formula to the left are often found.
2. Platelets, coagulogram.
3. Blood chemistry. The disease is characterized by an increase in C-reactive protein. Often revealed hyperbilirubinemia.
4. General urine analysis.
5. bacteriological research. Pale treponema is found in the contents of the blisters with pemphigus. The discharge of the nasal mucosa, umbilical cord tissue and placenta are examined.
6. Serological research methods: ELISA (enzymatic immunoassay) and RMP (microprecipitation reaction). ELISA detects such antibodies to syphilis in a newborn as immunoglobulins G and M.
7. Class G antibodies indicate that the mother of the baby had lues. Class M immunoglobulins are an indicator of an active process.
8. Immunofluorescence reaction (RIF) used to diagnose latent forms. RPG (passive hemagglutination reaction) is a highly sensitive test.
9. Oculist consultation.
10. Radiography of long tubular bones.
11. Ultrasound examination of the brain and abdominal organs.
12. If meningitis is suspected - lumbar puncture.

Important! CSF culture and microscopy are required.

Treatment

Includes such measures:

1. In a maternity hospital, symptomatic treatment is prescribed. If necessary, resuscitation measures are taken. There is an instruction on the transfer of sick newborns to a children's hospital.
2. Specific treatment aimed at combating the pathogen. Benzylpenicillin is widely used. In case of intolerance to antibiotics of the penicillin series, reserve drugs are prescribed: Ceftriaxone, Ampicillin.

For the prevention of dysbacteriosis, eubiotics are prescribed ("Linex", "Bifidumbacterin").

Prevention

During pregnancy, a woman should take a blood test for syphilis at least 3 times.

Preventive therapy of pregnant women. Expectant mothers often ask if it is possible to give birth to a healthy child after syphilis. If you have completed a course of treatment and followed all the recommendations of a venereologist, everything will end well.

Preventive therapy for children. It is prescribed if the mother was not treated during pregnancy. It happens that therapy is prescribed too late, or is carried out in violation of the protocol.

Frequently asked questions to the doctor

If the mother was sick in her youth

Good afternoon doctor! My name is Sergey. The wife admitted that at the age of 19 she had lues. I read on the Internet that now she will not be able to give birth to a healthy baby. Tell me please, is it possible to give birth after syphilis?

Hello Sergey! If your wife has completed the course of treatment, nothing threatens the unborn child. I recommend that you re-take tests before planning a pregnancy and follow medical recommendations.

Risk to the newborn

Hello! During my pregnancy, I found out that my husband had infected me with lues. They prescribed treatment. I'm very worried about the baby. Will he get sick?

Good afternoon Having a baby after syphilis treatment is absolutely safe. Follow all the instructions of the venereologist.

Will antibiotics hurt?

Hello, Doctor! Our family is in trouble. Doctors say my newborn daughter has congenital syphilis. Wife claims she was infected antenatal clinic where she was observed during pregnancy. They prescribed antibiotics, but she was afraid of hurting the baby. What will happen now?

Good afternoon It is unfortunate that your wife did not follow the doctor's orders. Prophylactic treatment of a pregnant woman prevents infection of the fetus. Congenital syphilis is much more dangerous to the health of the newborn than antibiotic therapy.

Not cured syphilis and childbirth after treatment are two different things. I am glad that the diagnosis was made on time and there is hope for a full recovery of the child. And, by the way, the infection of your wife in the antenatal clinic is absolutely excluded.

Late congenital syphilis - a disease received from the mother at birth through the blood, characterized by delayed onset of symptoms.

Most often, signs of the disease appear after ten years, sometimes in adults. In some cases, the disease can be detected in a child older than two years of age, but not earlier.

Congenital pathology develops when treponema enters the body of an unborn child through the umbilical cord with a blood or lymph flow from an infected woman. The fetus may be infected different terms pregnancy, pathologies are formed as the organs and systems of the unborn child develop.

Scientists believe that syphilis can affect the genetic apparatus of future parents. It can be provoked by pathological changes in the germ cells of the parents that occurred even before fertilization.

In some cases, the disease develops due to pathologies during embryogenesis, that is, the birth of the fetus. In some - due to pathologies formed under the influence of infection, during the formation and development of the body of the unborn child.

Clinical picture

Symptoms appear after two years of age, by five or six years, but most often the final clinical picture is formed in puberty. The clinical picture of pathology can be characterized as a set specific features characteristic of tertiary syphilis.

On the skin, mucous membranes there are a large number of syphilides (tumor-like nodes), inflammatory and purulent-necrotic processes develop in hard (bone and cartilage) and surrounding soft tissues.

Late congenital syphilis is observed in the absence of adequate therapy for the early form. In the vast majority of children, it passes without symptoms or is expressed in the presence of positive reaction in a blood test.

In some cases, early syphilis does not appear at all, even serologically.

The manifestations of congenital syphilis correspond to the symptoms of acquired tertiary. The patient has pathological disorders of the nervous system, rheumatoid manifestations, inflammatory processes in various organs: heart muscle, liver, lungs, gastrointestinal tract, as well as in hard tissues organism.

Symptoms

Late congenital syphilis is characterized by the presence of several groups of symptoms. The first group consists of symptoms that certainly indicate a pathology, the second group includes signs that, with a high degree of probability, indicate a disease, but require confirmation.

There is another group of symptoms that can be characterized as dystrophic changes, also observed in patients, but not directly indicating late syphilis.

Hutchinson triad

The so-called Hutchinson's triad, as well as the curvature of the bones of the lower leg relative to the sagittal plane, called the "saber tibia", are considered reliable symptoms. The Hutchinson triad includes such features as parenchymal keratitis, labyrinthine deafness, and dental dystrophy. All three pathologies are observed at the same time extremely rarely.

One of the symptoms indicating congenital syphilis is the underdevelopment of dental tissue caused by disturbances in the process of fetal formation. This is a symptom characterized by degeneration of dental tissues and enamel. The shape of the lower edge of the central incisors with such a lesion resembles a crescent or sickle, and the shape of the tooth itself differs in expansion near the gum, the tooth looks like a barrel or a screwdriver.

With such a lesion, there is a lack of enamel on the chewing edge. Such teeth grind down early, by about the age of twenty they become wide and short, with noticeable caries.

In almost half of cases of late syphilis, parenchymal keratitis is observed, which is part of the Hutchinson triad - this is the most common symptom indicating pathology. It appears as corneal clouding, uncontrolled tearing, photophobia. In most cases, the first pathology is observed in one eye.

Involvement in the pathological process of the second eye occurs after some time. The patient gradually loses visual function, a decrease in visual acuity is observed in everyone. Clouding of the cornea of ​​​​the eye can be both diffuse and focal in nature. Inflammatory processes of the iris, the posterior part of the eyeball, expansion vascular network, retinal lesions.

The third symptom from the Getchinson triad is noted quite rarely. Labyrinth deafness is mainly observed among female patients, aged five to fifteen years. Influenced inflammatory processes and hemorrhages against the background of dystrophic changes in the auditory nerves, deafness develops. With the development of pathology at the age of up to three years, speech disorders are also observed up to complete dumbness. This symptom is resistant to therapy.

Likely signs

These symptoms are not specific and require additional measures to confirm the diagnosis.

Often, patients have inflammation of the knee joint, characterized by swelling, low mobility in the absence of pain. This symptom is usually symmetrical. The ankles and elbow joints may also be affected.

Various pathologies of the nasal cartilage are observed in 20% of cases. Nose acquires various forms due to deformation of bones, their destruction under the influence of inflammatory processes. There are deformations of the skull against the background of inflammation of the bones. Most often, the frontal bones are deformed, forming two protrusions in the anterior upper part of the head.

In 20% of cases in patients with congenital pathology colloidal scarring occurs in the chin, neck, and around the lips. Pathology develops as a result of purulent processes at the age of up to a year.

In most cases, organic lesions of the central nervous system are diagnosed, characterized by mental retardation, speech disorders, insufficient muscle contractility up to complete paralysis, usually on the one hand.

Diagnostics

Diagnosis of pathology is carried out on the basis of information about a syphilitic infection in the anamnesis of the mother, active or cured. And also - the identification of specific pathologies indicating congenital syphilis, the presence of the Getchinson triad, as well as positive serological reactions.

Treatment

The main method of treatment of syphilis is the use of penicillin derivatives, prescribed in significant dosages and carried out for long courses. Treponema is the only microorganism to date that is sensitive to penicillin.

In case of individual intolerance or if the strain is found to be resistant, other antibiotics can be used for treatment. Effective antibiotics for the treatment of syphilis include erythromycin, tetracycline derivatives.

In case of damage to the central nervous system, methods of complex administration of antibiotics are used, along with taking pills and injections, drugs are also introduced into the subarachnoid space. This achieves successful overcoming of the blood-brain barrier.

Prevention

To date, congenital syphilis is extremely rare. Due to the fact that a system has been established for the timely detection and treatment of syphilis in the early stages, there has been a sharp drop in incidence rates. A strict record of patients with this disease is maintained.

The prevention of cases of this form of syphilis, in the first place, includes measures for the timely treatment of an acquired infection. All pregnant women should undergo the necessary studies, including analysis for serological reactions.

If syphilis is detected during gestation, future mother must undergo a full course of antisyphilitic therapy, as this greatly reduces the likelihood of developing pathology during the formation period.

Pregnant women with a history of syphilis are given prophylactic treatment, regardless of whether the appropriate therapy has been carried out and how successful it is.

If there is evidence that the expectant mother has not been fully cured of syphilis, the child is prescribed antisyphilitic treatment, regardless of the presence of signs of the disease and negative serological reactions.

Early congenital syphilis in children develops when the infection is transmitted from a sick mother to the fetus through the placenta. Pale treponemas enter the blood of the fetus with venous blood or through the lymphatic clefts of the umbilical vessels (infection before birth). Infection of the fetus can occur at different stages of its development, as well as when the expectant mother is infected with syphilis before pregnancy.

The penetration of pale treponemas and changes in the organs and tissues of the fetus begin from the moment of transition to placental circulation, which occurs at 4-5 months of pregnancy, therefore, specific treatment of a pregnant woman in the early stages guarantees the birth of a healthy child. Up to 90% of children die in utero or immediately after birth if the mother did not or received inadequate treatment. Most big risk the birth of a sick child is noted in the first years of the expectant mother's syphilis. In the case of infection of the fetus occurs in 100% of cases. Over the years, this ability weakens. Very rarely, cases of the birth of sick children from mothers with congenital syphilis are recorded.

Medical abortion, premature birth, death of a newborn, the birth of a child with syphilis, the birth of a child with latent syphilis or a healthy child (in 12% of cases) are the main outcomes of pregnancy in women with syphilis. The development of syphilis in the fetus depends on the degree of its immune response and the damaging ability of pathogens.

The most typical for syphilis are late miscarriages and the birth of a dead child at 6-7 months of pregnancy.

Rice. 1. Congenital syphilis in a child.

The defeat of the placenta is the first stage in the development of congenital syphilis

Specific changes in the fetus begin to be detected from the fifth month of development - from the moment the placental circulation is formed, when pale treponema begins to penetrate the placenta. With inflammation of the placenta, edema develops, connective tissue grows, and areas of necrosis appear. The walls of blood vessels are affected, which leads to their obliteration (closure). Significantly increases the mass of the placenta. Treponema pallidum enters the fetus from the umbilical cord through the umbilical vein or through the lymphatic slits of the umbilical vessels. Their the largest number concentrated in the liver, adrenal glands and spleen. The causative agents of syphilis can be found in the contents of the umbilical cord of the fetus.

Rice. 2. The scheme of development of congenital syphilis.

Classification of congenital syphilis

1. Fetal syphilis.
2. Early congenital syphilis (syphilis in children under the age of 2 years): a) syphilis in infants (from birth to one year of age); b) syphilis in children of early childhood (from one to two years).
3. Late congenital syphilis (syphilis in children older than 2 years).
4. Latent congenital syphilis (observed in all age groups).

Stillborn children and dead fetuses are contagious to others. Of particular danger in epidemiological terms are children with early congenital syphilis.

Fetal syphilis

Pale treponemas begin to penetrate into the body of the fetus with the development of placental circulation - from the fifth month of pregnancy. Diffuse inflammatory infiltration with subsequent proliferation of connective tissue leads to damage to internal organs. They thicken and increase in size.

The dead fetus is in the amniotic fluid for 3-4 days before its birth. During this time, his skin is saturated with liquid and swells (maceration). Stillborns have a small mass, they have damage to all vital organs, in which there is a large number of pale treponemas.

Signs of fetal syphilis

• Defeat placenta leads to malnutrition of the fetus, which is the cause of his death.
• Liver and spleen increase sharply. They form miliary syphilomas.
• Often the cause of fetal death is "white pneumonia", in which nested or diffuse small-cell interstitial infiltration, abundant desquamation of the epithelium, its fatty degeneration and filling of the alveoli with it, cell growth in the interalveolar space are noted. Affected lungs lose airiness, become heavy (sink in water), have a grayish-white color on the cut.
• There is damage to the cortex kidney, where diffuse punctate infiltration also develops.
• in the submucosal layer stomach and intestines flat infiltrates develop, some of them ulcerate.
• Heart is rarely affected.
• Of the endocrine glands most often affected adrenal glands, a little less pancreas, gonads And pituitary.
• Vessels are affected central nervous system. Inflammation of the soft and arachnoid membranes of the spinal cord and brain (leptomeningitis), meningoencephalitis and ependymatitis develop. The medulla oblongata is often affected.
• There is an intrauterine lesion skeletal system in the form of osteochondritis and osteoperiostitis - reliable fetus. Pathology is detected with the help of X-ray examination, carried out at 5-6 months of intrauterine development. A specific process develops in the growth zones of tubular bones.
• The fetus is damaged skin. The epidermis loosens, erodes and exfoliates in layers. The underdevelopment of the subcutaneous adipose tissue leads to the fact that the skin becomes wrinkled and gathers into folds, especially on the face (“old man’s face”).

Rice. 3. In the photo is a child with syphilis. The underdevelopment of the subcutaneous adipose tissue leads to the fact that the skin becomes wrinkled and gathers into folds, especially on the face (“old man’s face”).

Early congenital syphilis in infants

In the case of intrauterine infection with syphilis at the birth of a live child, they speak of syphilis in infants (from the moment of birth to one year). Conventionally, this period is divided into two: from the moment of birth to 3-4 months and from 3-4 months to one year.

• Up to 3-4 months, the child is dominated by common processes on the mucous membranes and skin in the form of syphilitic pemphigus and diffuse infiltration, lesions of the skeletal system in the form of periostitis, osteochondritis and dactylitis, lesions of internal organs, including the liver, spleen and nervous system.
• From 3 to 4 months, the severity of the manifestations of syphilis weakens. Separate rashes in the form of papules sometimes appear on the skin and mucous membranes, gummas are recorded in the bones, periostitis predominates, internal organs and the nervous system are affected much less frequently.

Manifestations of syphilis in a child are detected both immediately after birth and during the first 2 months of life and are extremely contagious (contagious).

In recent years, latent (hidden) forms of congenital syphilis have been increasingly recorded, which is associated with the widespread use of antibacterial drugs used by women for various reasons.

In classic cases, which are quite rare today, babies born have an "senile" appearance - they have wrinkled, flabby skin of a dirty yellow color, often covered with seborrheic scales, they put on weight slowly, develop slowly, often cannot suckle, are restless and anxious, sleep poorly, constantly crying.

Reliable signs of early congenital syphilis in infants are syphilitic pemphigus, diffuse skin infiltration of Gochsinger, syphilitic rhinitis, chorioretinitis, osteochondritis, and meningitis with hydrocephalus.

Rice. 4. Syphilitic pemphigus - the earliest sign of congenital syphilis.

Syphilitic pemphigus (syphilitic pemphigoid)

Pemphigus syphilis is the earliest sign of congenital syphilis in children. Bubbles are located on an infiltrated base of copper-red color, up to 1 cm in diameter, flabby, with serous-purulent or bloody contents. The palms and soles, the flexor surfaces of the forearms and lower legs, less often the trunk are their most frequent localization. Sometimes the rashes are located all over the body. Bubbles tend to merge, some of them dry up, others burst. The exposed surface becomes covered with crusts over time. The blisters contain a huge amount of syphilis pathogens. Serological tests give a positive result. Without treatment, children die. Differential diagnosis is carried out with staphylococcal pemphigoid (epidemic pemphigus).

Rice. 5. In the photo, syphilitic pemphigus (left) and a severe form of pemphigus of the newborn - Ritter's disease (right).

Diffuse skin infiltration of Gochsinger

Diffuse thickening of the skin is a reliable sign of congenital syphilis. It is based on defeat. small vessels. In the veins and arteries, perivascular infiltration with eosinophils, plasma and lymphoid cells is noted. The disease manifests itself at 8-10 weeks of a child's life.

The palms and soles, the area around the lips and the chin are the most common places for the localization of syphilis. Somewhat less often, infiltration appears on the thighs, buttocks, around the anus, scrotum, labia, scalp, on the skin of the elbows and knees. Initially, redness (erythema) occurs. Then the lesions of the skin areas are compacted, the folds are smoothed out, the lips thicken, swell and become yellowish-red in color, the red border of the lips becomes tense, and the skin on the soles and palms becomes “varnished” (“mirror soles”). When the process spreads to the scalp, hair loss is noted. When the process spreads to the region of the superciliary arches, hair loss on the eyebrows is noted.

Further, the affected surfaces are flaky, macerated (torn) and wet. Cracks occur at the slightest cry of a child and mechanical trauma, spread to the red border of the lips, bleed and quickly become covered with crusts. All damage elements contain a huge amount of pale treponema.

After 2-3 months, diffuse infiltration is resolved even without treatment. Radial scars (Robinson-Fournier scars) remain at the site of inflammation in the corners of the mouth. Radial scars are pathogomonic.

Rice. 6. In the photo, early congenital syphilis is a diffuse infiltration of the Gochsinger skin.

Syphilitic rhinitis

Syphilitic rhinitis appears most often immediately after birth or in the first month of a child's life. The disease develops as a result of diffuse infiltration of leukocytes and round cells of the anterior part of the nasal mucosa, as a result of which it swells. There are fetid, purulent-bloody discharges from the nose, which, when dried, form massive crusts. Swelling of the mucosa and dense crusts make breathing much more difficult, because of which the child cannot suckle at the breast. Nosebleeds are noted.

Over time, the ulcerative process spreads to cartilage and nasal bones. The nasal septum undergoes necrosis. The bone-cartilaginous skeleton is deformed and the nose takes the form of a saddle.

Sometimes diffuse infiltration affects the mucous membrane of the larynx. Developed ulcerative laryngitis is manifested by hoarseness of voice. The destruction of the cartilage leads to stenosis of the organ.

Rice. 7. Syphilitic rhinitis and diffuse skin infiltration are symptoms of congenital syphilis.

Bone lesion

Syphilitic osteochondritis

Syphilitic osteochondritis (Wegener's osteochondritis), periostitis and isolated gummas are considered a constant symptom of early congenital syphilis. In children older than one year, osteochondritis is extremely rare, and after a year and a half of life they never occur.

Osteochondritis is formed from the fifth month of intrauterine development of the fetus and is most often detected in the first three months of a child's life. Osteochondritis is often the only manifestation of congenital syphilis. The disease is characterized by damage to long tubular bones (usually the upper limbs) at the border of the diaphysis and epiphysis, where there are disturbances in the formation of calcium and inhibition of the development of osteoblasts. Less commonly, flat bones and phalanges are damaged. With the disintegration of a specific infiltrate, the epiphysis is separated from the diaphysis. In the second and third stages of syphilitic osteochondritis, pathological fractures may appear. The resulting pains become excruciating, they occur at the slightest movement of the child. Similar state is called Parro's pseudo-paralysis.

Under the influence of antisyphilitic treatment, the pathological process stops and does not affect bone growth in the future.

Syphilitic periostitis

Together with osteochondritis, and sometimes alone with congenital syphilis, periostitis occurs - a lesion of the periosteum. Periostitis in initial stage their development go unnoticed even on the x-ray. The first manifestations of periostitis can be seen only with calcification of the periosteum. Periostitis is accompanied by pain in the area of ​​long tubular bones - the places of development of the pathological process.

Gum in the bones

The gummous process in early congenital syphilis is rarely recorded. The ulna, tibia and flat bones are the most common sites for the development of syphilitic gums. Gummas in the bones represent isolated foci round shape single or multiple. They are located under the periosteum and often in the bone marrow. The periosteum in the area of ​​gumma thickens and becomes like a muff.

Syphilitic phalangitis (dactylitis)

With congenital syphilis, the phalanges of the upper extremities are more often affected. Couplings (thickening of the periosteum) make the fingers look like barrels.

Rice. 8. Scheme of development of syphilitic osteochondritis. In the affected bone in the metaphysis, a rarefaction zone appears in the form of a white strip (B). The zone of preliminary ossification has a jagged appearance.

Rice. 9. In the photo, syphilitic osteochondritis (left) and periostitis (right).

Rice. 10. When bones are damaged, even passive movements or careless touches cause severe suffering to the child.

Rice. 11. The defeat of the bones of the skull with syphilis in children.

Damage to the central nervous system

Hydrocephalus(dropsy of the brain) and chronic leptomeningitis (inflammation of the membranes of the spinal cord and brain, including arachnoid and soft) - reliable signs congenital syphilis.

Hydrocephalus (excessive accumulation of cerebrospinal fluid in the ventricles of the brain) with congenital syphilis develops as a result of inflammation of the pia mater. More often, children are born with hydrocephalus, less often hydrocephalus develops in the third month of a child's life. The disease can be acute or chronic. With hydrocephalus, all dimensions of the skull increase, it takes an elongated shape, the parietal and frontal tubercles increase and protrude, the fontanel is tense, the sutures diverge, the eyeballs are protruded and shifted downward. There is an increased number of lymphocytes and protein in the cerebrospinal fluid.

Pia mater and vascular walls leptomeningitis thickened (infiltrated with fibroblasts, lymphoid and plasma cells). When the meninges are irritated, the child screams “for no reason”. Convulsions, paresis and strabismus often occur. Stiff neck, restlessness, short-term convulsions, paralysis, and uneven pupils are the main symptoms of meningitis with syphilis.

Inflammation affects the substance brain, glial proliferation and the formation of glial nodules are noted, vessels are sclerosed.

Paresis and paralysis are the main signs of syphilitic meningoencephalitis. Sometimes asymptomatic syphilitic meningitis is recorded, the only sign of which is changes in the cerebrospinal fluid.

Rice. 12. Enlargement of the liver and spleen is a sign of congenital syphilis.

Syphilitic chorioretinitis

Chorioretinitis and optic nerve atrophy are sometimes the only manifestation of congenital syphilis.

• For syphilitic chorioretinitis the symptom of “salt and pepper” is characteristic, which is characterized by the appearance of clumps of pigment and zones of depigmentation along the periphery of the fundus. The disease leads to changes in the retina and choroid. Visual acuity is not reduced.
• Blurred contours of the disc - a symptom of the lesion optic nerve, which atrophies as a result of the disease, which leads to loss of vision.

With syphilis in infants, a combination of chorioretinitis and damage to the optic nerve is more common.

Rice. 13. In the photo, chorioretinitis with early congenital syphilis.

Damage to internal organs

Syphilitic lesions of the internal organs are characterized by infiltrative-productive inflammation and less often by the development of gummous formations. In 100% of cases with syphilis, the liver and spleen are affected, in 94% of cases - the vessels, in 85% of cases - the adrenal glands, the kidneys, pancreas, bones and testicles are less often affected. Damage to internal organs begins in utero.

The first organ to be affected in the fetus is liver. At the same time, weakness is noted in newborns, anemia, cachexia develop, the skin acquires an earthy color.

The same process develops in spleen, which also increases in size. developed pneumonia becomes the cause of death of the newborn in the first days of life.

With syphilitic lesions hearts all its membranes, valves and vessels are affected.

About development nephroso-nephritis say changes in the urine and the development of anemia in the newborn.

Dysfunction thyroid, pancreas, thymus And gonads,pituitary gland And adrenal glands is also a sign of congenital syphilis. When the testicle is damaged, the organ increases, becomes smooth, dropsy is sometimes recorded. The pancreas acquires cartilaginous density.

Defeat vessels myocardium, liver, spleen and kidneys in the form of obliterating endarteritis leads to ischemic necrosis.

sclerosed lymphatic vessels, cervical, elbow, inguinal and other groups increase and become denser lymph nodes.

Congenital syphilis is most severe in premature babies and children in whom manifestations of the disease are recorded from the first week of life. Their disease often ends in death.

Rice. 14. Papular rash in congenital syphilis. The lower extremities and scrotum are affected.

Congenital syphilis of early childhood (from 1 year to 2 years)

Signs and symptoms of congenital syphilis in early childhood (1 to 2 years of age) resemble secondary recurrent syphilis:

• warts the anus is the most characteristic symptom of the disease. Warts can reach large sizes, are often grouped, the surfaces of some of them are eroded. Condylomas are also located in large folds of the skin and on the skin of the genital organs.
• There is often an increase liver And spleen. Somewhat less commonly affected kidneys. Sometimes syphilitic changes are found in thyroid gland And pituitary gland.
• Hypochromia often develops anemia.
• syphilitic periostitis s and osteoperiostitis detected only radiographically.
• Papular rash appears on the mucous membrane of the cheeks, tongue and tonsils. Papules in the corners of the mouth become wet, covered with purulent crusts, reminiscent of seizures. Papules on the mucous membrane of the larynx tend to merge and form a diffuse infiltration, which is manifested by hoarseness and even aphonia. Sometimes stenosis of the larynx develops. Syphilitic rhinitis develops less frequently than in infants. All elements of the rash contain a large number of pale treponema.
• Sometimes diffuse or focal hair loss(alopecia).

In some cases, with congenital syphilis in young children, monosymptomatic and latent syphilis is observed.

At monosymptomatic damage develops either only to the mucous membranes and skin, or internal organs, or tubular bones.

At latent syphilis the mother has a syphilitic infection, the child has no symptoms of the disease, the results of the study of cerebrospinal fluid are negative, and serological reactions for syphilis are sharply positive. Latent form of congenital syphilis is more common than overt.

Currently, with overt syphilis, lesions of the nervous system, organs of vision, bones and joints are much more common than skin rashes characteristic of syphilis.

Rice. 16. Condylomas of the anus are the most characteristic sign of congenital syphilis in children 1-2 years old.