Pale treponema

congenital syphilis

Early congenital syphilis

List of abbreviations

i / m - intramuscularly

VS - congenital syphilis

ED - units

ZVUR - delay prenatal development

ELISA - enzyme immunoassay

ICC - immunocytochemical analysis

kg - kilogram

mg/kg - milligram per kilogram

NTT - non-treponemal tests

PCR - polymerase chain reaction

RIBT - reaction of immobilization of pale treponemas

RIF - immunofluorescence reaction

RMP - microprecipitation reaction

RPHA - passive hemagglutination reaction

CNS - central nervous system

RW - Wasserman reaction

Terms and Definitions

Syphilis- an infectious disease caused by pale treponema (Treponema pallidum), transmitted mainly sexually, characterized by lesions of the skin, mucous membranes, nervous system, internal organs and musculoskeletal system

congenital syphilis- is the result of transplacental transmission of the pathogen by a sick mother to the fetus, characterized by a variety of specific and non-specific manifestations and age-related periodicity.

1. Brief information

1.1 Definition

Syphilis- a chronic infectious disease caused by pale treponema, characterized by a systemic lesion of the body and a staged course.

1.2 Etiology and pathogenesis

The causative agent of syphilis belongs to the order Spirochaetales, family Spirochaetaeceae, genus Treponema, species Treponemapallidum, subspecies pallidum (syn. Spirochaetapallidum). Pale treponema is easily destroyed under the influence of external agents: drying, heating at 55? C for 15 minutes, exposure 50 - 55? solution ethyl alcohol. At the same time, low temperatures contribute to the survival of pale treponema. Treponema pallidum is a spiral-shaped microorganism, but can also exist in the form of cysts and L-shaped. The cyst is a survival form of treponema pallidum in adverse conditions environment and is considered as the dormant stage of T. pallidum; has antigenic activity. The L-form is a way of survival of pale treponema, has a weak antigenic activity.

Infection of the fetus with syphilis occurs transplacentally, starting from the 4th month of pregnancy. With untreated syphilis, a mother can infect her children throughout the entire childbearing period, but the most dangerous for offspring are the first 3 years from the moment of infection, which corresponds to the primary, secondary and early latent period of acquired syphilis.

1.3 Epidemiology

Syphilis is found everywhere. The incidence rate fluctuates around 40.0 per 100,000 population, depending on the region. The incidence of congenital syphilis in last years in the Russian Federation averages 0.59 per 100,000.

According to official state statistical reporting, the epidemiological situation of syphilis is characterized by a gradual decrease in the incidence in the Russian Federation as a whole (in 2009 - 53.3 cases per 100,000 population; in 2012 - 33.1 cases per 100,000 population).

1.4 ICD 10 coding

congenital syphilis(A50):

A50.0 - Early congenital syphilis with symptoms;

A50.1 Early latent congenital syphilis;

A50.2 - Early congenital syphilis, unspecified;

A50.9 - Congenital syphilis, unspecified.

1.5 Classification

Clinical classification:

Early congenital syphilis;

Latent congenital syphilis.

2. Diagnostics

2.1 Clinical picture

The presence or absence of manifestations of congenital syphilis in a newborn depends on the stage of mother's syphilis, her concomitant diseases and bad habits, which can contribute to damage to the placenta and easier penetration of pale treponema into the fetus.

2.1.1 Early congenital syphilis with symptoms in the newborn

It is characterized by 3 groups of symptoms:

pathognomonic for congenital and not found in acquired syphilis:

syphilitic pemphigus,

diffuse infiltration of the Gochsinger skin,

specific rhinitis,

osteochondritis of Wegner's long bones;

typical manifestations syphilis:

papular rash on the limbs, buttocks, face, sometimes all over the body;

erosive papules and wide warts in places of maceration;

roseola rash,

alopecia,

bone lesions in the form of periostitis, osteoporosis and osteosclerosis, bone gums;

damage to internal organs.

general and local symptoms found in other intrauterine infections.

This group of patients is characterized by a specific appearance: they are usually premature or underweight babies with signs of intrauterine growth retardation (IUGR). The skull is deformed, enlarged in volume, with a pronounced venous network, its brain part predominates, low location and deformation of the auricles, short neck, wide bridge of the nose and retraction of the root of the nose, why the face the child looks small and wrinkled, with a characteristic "senile" expression - "little old men." There is an increase in the size of the abdomen, the presence of a vascular network.

The severity of the condition of a newborn child may be due to a syndrome of respiratory disorders. On the part of the lungs, manifestations of intrauterine pneumonia, multiple atelectasis, and underdevelopment of the lung tissue are characteristic. Perhaps severe damage to the central nervous system due to ischemia and hypoxia of the brain, the development of hemorrhages, intracranial hypertension, meningoencephalitis. Often there is a lesion of parenchymal organs in the form of hepatomegaly, splenomegaly, specific hepatitis. Hypochromic anemia and thrombocytopenia are often detected, resulting in a hemorrhagic syndrome.

Specific signs that are characteristic only of congenital syphilis include damage to the skin, mucous membranes, bones and the central nervous system (CNS). One of the early and typical manifestations of active congenital syphilis is pemphigus syphilis. Usually blisters are localized on the palms and soles, less often they are located on the shins and forearms. The skin at the base of the blisters is compacted, congestively hyperemic. Bubbles have sizes from 3 to 10 mm in diameter, a fairly dense tire, transparent or cloudy contents. They usually do not increase in size, do not merge with each other, when opened, they form erosion with subsequent layering of crusts, and if they do not open, then they shrink and then peel off. Treponema pallidum can be found in the contents of the blisters, which contributes to early diagnosis syphilis.

A specific manifestation of early congenital syphilis is a diffuse papular infiltration of Gochsinger. More often at the end of the first and second months of a child's life, thickening and redness of the skin of the feet, buttocks, and face appear. The skin in the lesions becomes tense and shiny, as if "varnished". Later on the face, especially around the mouth, on the lips and chin, deep bleeding cracks form, covered with crusts. The outcome of diffuse papular infiltration on the face is radiar scars (Robinson-Fournier scars), which persist throughout life.

A significant sign of early congenital syphilis is a papular, less often roseolous rash, which usually occurs at 2-3 months of age. It is localized on the trunk, limbs, sometimes on the face. Rashes are usually not grouped, but merge and erode only in folds. After their resolution, unstable pigmentation remains. Syphilitic paronychia appear at 2-3 months of age, capture the periungual folds and can be combined with periostitis of the distal phalanges of the fingers.

Early congenital syphilis is characterized by specific rhinitis, which can be detected already at birth by swelling of the nasal mucosa and difficulty in nasal breathing (stage I). Then there is an abundant mucopurulent discharge, which dries up in the nasal passages into dense crusts (stage II). The mucous membrane can ulcerate, which leads to the appearance of blood in the discharge and even nosebleeds (stage III). In the future, a specific process passes to the cartilaginous and bone tissues of the nose, which is clinically manifested by nose deformity.

The mucous membranes of the oral cavity and larynx may be involved in the pathological process. On the mucous membrane of the cheeks, back of the tongue, soft palate and tonsils, papular rashes can be detected. Due to maceration, papular elements can erode. Due to rashes on the mucous membrane of the larynx, children may experience hoarseness of voice up to complete aphonia.

The most common specific sign of early congenital syphilis is bone damage. In this case, osteochondritis develops, in which there is a violation of endochondral ossification, due to inhibition of the development of osteoblasts. Osteochondritis is more often detected in the first 3 months of a child's life. Radiographically distinguish three degrees of osteochondritis. At grade I, a dark, slightly serrated strip up to 2 mm wide (normally 0.5 mm) is revealed in the zone of preliminary calcification. In grade II osteochondritis, the dark strip is wider (2–4 mm), the serration is distinct, directed towards the epiphysis. Radiographically, there is usually an extended zone of calcification around an uneven rarefaction band. With grade III osteochondritis, granulation tissue forms under the cartilage closer to the diaphysis. Clinically, it is possible to detect only grade III osteochondritis, when the child reacts painfully to any manipulations, and Parro's pseudoparalysis, when there are no active movements in the affected limbs, the position of the hands resembles seal flippers, and the lower limbs are bent at the knees.

In addition to osteochondritis, periostitis is detected in children with early congenital syphilis. On radiographs, periostitis is represented by a thickening of the periosteum in the form of a rather wide ossified band or layered overlays. Usually, periostitis is located in the region of the tibia and fibula, the radius, and occasionally periostitis of the ribs is detected.

A reliable sign of early congenital syphilis is damage to the organ of vision in the form of chorioretinitis, parenchymal keratitis, and atrophy of the optic nerve.

Often, congenital syphilis is manifested by internal hydrocephalus and chronic syphilitic leptomeningitis. It is clinically characterized by lethargy of the child, frequent regurgitation, monotonous crying or unreasonable screaming (Sisto's symptom), convulsive syndrome, focal symptoms. Symptoms of specific lesions are often vague, but lumbar puncture should be performed in every case of congenital syphilis or when it is suspected. In the cerebrospinal fluid, lymphocytic cytosis and an increased protein content are detected.

The most common symptom in early congenital syphilis is hepatomegaly - detected in 60% of patients, and splenomegaly - in 30%.

2.1.2 Latent congenital syphilis characterized only by positive serological blood tests in the absence of any clinical manifestations. In mothers of such patients, untreated or insufficiently treated syphilis is detected by the time of delivery.

2.2 Laboratory diagnostics

2.2.1 Diagnosis of congenital syphilis in the antenatal period

Absolute evidence of the presence of the disease is the detection of pale treponema in samples obtained from a pregnant woman.

2.2.2 Diagnosis of congenital syphilis in a newborn

Non-treponemal tests:

microprecipitation reaction (RMP) with plasma and inactivated serum or its analogues:

RPR (RPR) - rapid plasma reagins test (Rapid Plasma Reagins), or rapid test for plasma reagins

VDRL - Venereal Disease Research Laboratory test - test Research laboratory sexually transmitted diseases

TRUST - test with toluidine red and unheated serum

(ToluidinRedUnheatedSerumTest)

USR - Unheated Serum Reagins test

Comments: general characteristics non-treponemal tests:

an antigen of non-treponemal origin is used - a standardized cardiolipin antigen;

early positivity;

the ability to determine antibody titers;

they have low sensitivity (up to 70–90% in early forms of syphilis and up to 30% in late forms), and can give false positive results (3% or more).

Benefits of non-treponemal tests:

technical ease of implementation;

speed of obtaining results.

Indications for the use of non-treponemal tests:

screening the population for syphilis;

determination of the activity of the course of infection (determination of antibody titers);

monitoring the effectiveness of therapy (determination of antibody titers).

Treponemal tests:

ELISA (enzymatic immunoassay) - Sensitivity for congenital syphilis - 98-100%, specificity - 96-100%. Enables differentiated and total determination of IgM and IgG antibodies to the causative agent of syphilis;

Western blotting is a modification of ELISA. Sensitivity and specificity - 98-100%. May be used to confirm the diagnosis, especially when other treponemal tests are questionable or inconsistent.

the IHL method, (immunochemiluminescence), which has high sensitivity and specificity (98-100%), makes it possible to quantify the level of antibodies to the causative agent of syphilis, can be used to confirm syphilitic infection and screening.

PBT (Simple Rapid Bedside Tests or Immunochromatographic Tests) allows rapid determination of treponemo-specific antibodies to the causative agent of syphilis in serum and whole blood samples without the use of special laboratory equipment.

RPHA (passive hemagglutination test) is a highly sensitive and specific test. Sensitivity in congenital syphilis - 76%? 100%, with latent - 94?97%, specificity - 98-100%;

RIF (immunofluorescence reaction, including RIFabs and RIF200 modifications) is quite sensitive at all stages of syphilis, specificity is 94-100%. RIF is used to differentiate latent forms of syphilis and false-positive results of studies on syphilis;

RIBT (RIT) (treponema pallidum immobilization test) is a classic test for the detection of specific treponemal antibodies; sensitivity (total by stages of syphilis) is 87.7%; specificity - 100%.

General characteristics of treponemal tests:

antigen of treponemal origin is used;

sensitivity - 70-100% (depending on the type of test and the stage of syphilis);

specificity - 94-100%.

RIF, ELISA, immunoblotting (IB) become positive from the 3rd week from the moment of infection and earlier, TPHA and RIBT - from the 7th–8th.

Benefits of treponemal tests:

high sensitivity and specificity.

Indications for the use of treponemal tests:

confirmation of positive results of non-treponemal tests;

confirmation in case of discrepancy between the results of the screening treponemal test and the subsequent non-treponemal test, as well as the screening and confirmatory treponemal tests;

screening of certain categories of the population for syphilis (donors, pregnant women, patients of ophthalmological, psychoneurological, cardiological hospitals, HIV-infected) using the methods of ELISA, RPGA, IHL, PBT.

Comments:

treponemal tests cannot be used to monitor the effectiveness of therapy, because antitreponemal antibodies circulate for a long time in the body of a patient who has had a syphilitic infection;

• treponemal tests give positive results in non-venereal treponematoses and spirochetosis;

  treponemal tests can give false positive reactions in patients with autoimmune diseases, leprosy, oncological diseases, endocrine pathology, and some other diseases.

3. Treatment

3.1 Conservative treatment

Specific treatment of children with early congenital syphilis

Recommended benzylpenicillin sodium salt crystalline **: children under the age of 1 month - 100 thousand units per kg of body weight per day, divided into 4 injections (every 6 hours) intramuscularly (i.m.) for 20 days with monosymptomatic and latent forms early congenital syphilis, and within 28 days - with overt syphilis and CNS damage (confirmed by positive cerebrospinal fluid serological reactions).

Comments: If the mother refuses to perform a lumbar puncture to the child, the course of treatment should also be 28 days. These terms of treatment should also apply to alternative methods of treatment (Ampicillin **, Ceftriaxone **).

Benzylpenicillin novocaine salt** 50 thousand units per kg of body weight per day, divided into 2 injections (every 12 hours) in / m for 20 days.

When indicating the presence of allergic reactions to penicillin, it is recommended to use reserve drugs:

Ceftriaxone** for children of the first two months of life is prescribed at a dose of 50 mg/kg of body weight per day in 2 injections.

Comments:The duration of treatment for overt or latent early congenital syphilis is 20 days, for early congenital syphilis with CNS damage - 28 days.

Ampicillin** 100 thousand units per kg of body weight 2 times a day from 1 to 8 days of life, 3 times a day - from 9 to 30 days of life. With overt and latent forms of early congenital syphilis, the duration of treatment is 20 days, with damage to the central nervous system, within 28 days.

Comments:With overt and latent forms of early congenital syphilis, the duration of treatment is 20 days, with damage to the central nervous system, within 28 days.

If after 6-12 months positive non-treponemal tests (NTT) persist and a fourfold decrease in titer has not occurred, children should be re-examined with a mandatory CSF study and, if necessary, an additional 10-day course of treatment with benzylpenicillin sodium salt should be carried out.

4. Rehabilitation

There is no rehabilitation.

5. Prevention and follow-up

5.1 Prevention

Prevention of congenital syphilis

Comments: Prophylactic treatment is indicated for newborns born without manifestations of syphilis from an untreated or inadequately treated mother during pregnancy (specific treatment started after the 32nd week of pregnancy, with a violation or change in approved treatment regimens), as well as newborns whose mother, if indicated, did not receive prophylactic treatment during pregnancy.

Preventive treatment for children

Preparations, single doses and frequency of administration correspond to those for specific treatment.

The duration of therapy for newborns whose mother did not receive preventive treatment or received inadequate treatment is 10 days, and for newborns without manifestations of syphilis from an untreated mother - 20 days.

Criteria for assessing the quality of medical care

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Annex A1. Composition of the working group

Vasiliev Valery Viktorovich - Head of the Department of Congenital infectious pathology- Leading Researcher of the Federal State Budgetary Institution Research Institute of Children's Infections of the Federal Medical and Biological Agency of Russia, Professor of the Department of Infectious Diseases, North-Western State Medical University. I.I. Mechnikova, professor, doctor of medical sciences.

Volodin Nikolai Nikolaevich - Academician of the Russian Academy of Sciences, Professor, Doctor of Medical Sciences. President of RASPM, FGBU FNKTs DGOI them. Dmitry Rogachev

Gorshkov Dmitry Alexandrovich - Resuscitator of the neonatal intensive care unit of the Federal State Institution "North-Western Federal Medical Research Center named after A.I. V.A. Almazova,

Ivanov Dmitry Olegovich - chief freelance specialist of the Ministry of Health of the Russian Federation in neonatology, rector of St. Petersburg State Pediatric Medical University, doctor of medical sciences, professor.

Lobzin Yury Vladimirovich - Director of the Research Institute of Children's Infections of the Federal Medical and Biological Agency of Russia, Academician of the Russian Academy of Sciences, Professor, Doctor of Medical Sciences

Petrenko Yury Valentinovich - chief neonatologist of the Northwestern Federal District of Russia, vice-rector for medical work of St. Petersburg State Medical University

Fedoseeva Tatyana Alexandrovna - Senior Researcher, Research Laboratory of Physiology and Pathology of Newborns, Institute of Perinatology and Pediatrics, N. V.A. Almazova

Gorlanov Igor Alexandrovich - Head of the Department of Dermatovenereology, St. Petersburg State Pediatric Medical University, Professor, Doctor of Medical Sciences

Kuzmin Vladimir Nikolaevich - Professor of the Department of Reproductive Medicine and Surgery, MD

Kurtser Mark Arkadievich - Chairman of the Board of Directors of the group of companies "Mother and Child", Corresponding Member of the Russian Academy of Sciences, Professor

Leina Larisa Mikhailovna - Associate Professor of the Department of Dermatovenereology, St. Petersburg State Pediatric Medical University, Candidate of Medical Sciences

Milyavskaya Irina Romanovna - Associate Professor of the Department of Dermatovenereology, St. Petersburg State Pediatric Medical University, Candidate of Medical Sciences

Ovsyannikov Dmitry Yurievich - Head of the Department of Pediatrics of the Peoples' Friendship University of Russia, MD

Pankratyeva Lyudmila Leonidovna - Federal State Budgetary Institution Federal Scientific and Practical Center of the Far Eastern State Institute named after Dmitry Rogachev, Head. department, c.m.s.

Shabalov Nikolai Pavlovich - Head of the Department of Children's Diseases of the Military Medical Academy. CM. Kirov.

Conflict of interest. All members of the Working Group confirmed that there was no financial support/conflict of interest to report.

Pediatrics;

Neonatology;

Obstetrics and gynecology.

Methodology

Methods used to collect/select evidence: electronic database searches.

Description of the methods used to collect/select evidence: the evidence base for recommendations are publications included in the Cochrane Library, the EMBASE and MEDLINE databases, and the electronic library (www.elibrary.ru). The search depth was 5 years.

Methods used to assess the quality and strength of evidence:

expert consensus;

Methods used to analyze the evidence:

systematic reviews with tables of evidence.

Description of the methods used to analyze the evidence

When selecting publications as potential sources of evidence, the methodology used in each study is reviewed to ensure its validity. The outcome of the study affects the level of evidence assigned to the publication, which in turn affects the strength of the recommendations that follow from it.

The methodological study is based on several key questions that focus on those features of the study design that have a significant impact on the validity of the results and conclusions. These key questions may vary depending on the types of studies and the questionnaires used to standardize the publication evaluation process.

The evaluation process, of course, can be affected by the subjective factor. To minimize potential errors, each study was evaluated independently, ie. at least two independent members working group. Any differences in assessments were already discussed by the entire group. If it was impossible to reach a consensus, an independent expert was involved.

Evidence tables were filled in by members of the working group.

Methods used to formulate recommendations: expert consensus.

external expert evaluation;

internal peer review.

These draft recommendations have been peer-reviewed by independent experts who were asked to comment primarily on the extent to which the interpretation of the evidence underlying the recommendations is understandable. Comments were received from primary care physicians and district therapists regarding the intelligibility of the presentation of recommendations and their assessment of the importance of recommendations as a working tool for everyday practice.

The draft was also sent to a non-medical reviewer for comments from a patient perspective.

Congenital syphilis is called, which is transmitted to the unborn child transplacentally through the mother's blood. Congenital syphilis is early and late.

Early congenital syphilis includes fetal syphilis, infancy syphilis, and early childhood syphilis.

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

Fetal syphilis occurs around the 5th month of pregnancy, when pale treponemas penetrate the placenta and actively multiply inside the fetus.

Fetal syphilis affects literally all the internal organs, brain and skeletal system of the fetus, so the chances of surviving the fetus are very low. Usually, fetal syphilis ends with his death on the 6-7th lunar month pregnancy or premature birth dead child.

According to the medical literature, 89% of pregnancies in women with secondary syphilis end in fetal death or stillbirth.

Some children transplacentally infected with syphilis survive, but often such children, especially those born with active manifestations of syphilis, are not viable and die in the first days or months after birth.

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If the child remains alive, then, as a rule, he has very strong violations of all body systems. Children with early congenital syphilis are weak, develop poorly, lag behind in height and body weight, and are underdeveloped both physically and mentally.

In children with early congenital syphilis of infancy, the eyes are often affected, as well as internal organs: the liver, spleen, cardiovascular system. With early congenital syphilis, lesions of the skin, bones and cartilage, and teeth are often observed. Dropsy of the brain or syphilitic inflammation of the meninges may develop.

Early congenital syphilis in children can occur both with symptoms of syphilis, that is, skin rashes, and in a latent form - asymptomatically. However, even with latent congenital syphilis, the disease is easy to determine by positive serological reactions in the blood and cerebrospinal fluid.

Children with early congenital syphilis between 1 and 2 years of age may present with:

• papular rashes

Around anus, in the genital area, buttocks, less often on the mucous membrane of the mouth, larynx, nose. Papules can be localized on the palms and soles, on the skin of the face, mainly around the mouth and on the chin, less often in the forehead and superciliary arches. At the same time, radially located cracks form around the mouth, which, when healed, form a kind of radial scars. These scars are a very characteristic sign of congenital syphilis that remains for life.

• syphilitic pemphigus

The most common type of syphilitic rash in early congenital syphilis. Syphilitic pemphigus is a blisters that are most often localized on the palms and soles of the child, less often on the flexor surfaces of the forearms and legs or on the trunk. Pemphigus is often observed already at the birth of a child or occurs in the first days and weeks of his life.

• syphilitic rhinitis

It is also a characteristic sign of congenital syphilis in infants. Rhinitis with syphilis occurs due to the inflammation that a papular rash causes on the nasal mucosa. With syphilitic rhinitis, nasal breathing is difficult, the child is forced to breathe through the mouth.

• osteochondritis

Another sign of early congenital syphilis in infants is syphilitic bone disease. Osteochondritis most often affects the limbs, causing local tension, swelling and pain in the affected area.

• periostitis and osteoperiostitis

Symptoms of bone system disorders in early congenital syphilis are observed in 70-80% of patients.

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After the first year of illness, the symptoms of early congenital syphilis usually disappear. As with syphilis acquired in adulthood, recurrent rashes on the skin and mucous membranes in the form of roseola or papules are possible. In addition, damage to the larynx, bones, nervous system, liver, spleen and other organs is possible.

As for late congenital syphilis, it can also occur in a latent form in the presence of positive serological reactions, and it can manifest itself with certain clinical symptoms. As a rule, late congenital syphilis is detected at the age of 15-16 years, sometimes later, but sometimes earlier.

The most dangerous symptoms of late congenital syphilis:

• eye damage (sometimes up to complete blindness);
• damage to the inner ear (syphilitic labyrinth with irreversible deafness);
• gummas of internal organs and skin;
• change in the shape of the teeth (in which a semilunar notch appears along the free edge of the upper incisors)

Possible signs of late congenital syphilis include:

• "saber" shins;
• scars around the mouth;
• "buttock-shaped skull";
• saddle nose (in 15-20% of patients there is a characteristic symptom due to the destruction of the nasal bones and the bone part of the nasal septum);
• tubercles and gums can form on the skin of the patient;
• defeat occurs very often endocrine system

Congenital syphilis can be cured using modern medicine, and this should be done as soon as possible, until the changes caused by syphilis in the child's body become irreversible. Therefore, even before the onset of pregnancy, a woman with syphilis should certainly consult with a venereologist, and if the mother’s illness became known during pregnancy, the woman needs to undergo a course of syphilis treatment herself and carry out preventive treatment of the child immediately after birth.

The gynecologists of our medical center are always ready to help you plan a desired and healthy pregnancy.

Syphilis remains one of the most common and dangerous sexually transmitted diseases in modern healthcare: congenital syphilis occupies a special place in the structure of this pathology. Despite the fact that WHO reports a significant reduction in the incidence of this intrauterine infection, doctors have to deal with this complication in their daily practice. In our review, we will consider the causes, the mechanism of development, clinical features, as well as the principles of diagnosis and therapy of congenital syphilis.

The essence of the problem

So what is congenital syphilis? This pathology is accompanied by transplacental transmission of the pathogen Treponema palidum to the unborn child from a sick mother. In this case, the infection of the fetus occurs both if the woman was ill before conception, and when she was infected during the bearing of the baby. Depending on the time of development, congenital syphilis is divided into early and late forms.

Early syphilitic lesions include infection of the fetus, infants (up to 1 year old) and preschool children (aged 1-4 years). The late form of the infection is distinguished by a long and almost asymptomatic course: it is diagnosed, as a rule, after four years. Separately, latent congenital syphilis is distinguished, which is diagnosed in a child only on the basis of laboratory tests.

According to Rosstat, over the past 10 years, the incidence of the infection in question in children younger age decreased by 80%, in adolescents - by 78%. This became possible, first of all, due to the active implementation of measures to prevent congenital forms of infection. Examination of women registered with an obstetrician-gynecologist for pregnancy is carried out twice or thrice. Syphilis is detected in the early stages or in the second trimester (34% and 38%, respectively). This allows you to start adequate antimicrobial therapy in a timely manner and prevent transplacental penetration of spirochetes into the fetus.

Important! In 2013, 112 cases of congenital syphilis were registered in the Russian Federation. In 2014, the same indicator was 86 cases. Most of the sick children were born from mothers who were not observed in antenatal clinics.

Causes and mechanism of development

The main cause of congenital syphilis is the bacteria Treponema pallidum, one of the types of gram-negative spirochetes discovered in 1905 by German researchers F. Schaudin and E. Hoffmann. Pale treponema is an elongated microorganism, twisting into 8-14 curls. Its dimensions are 8-20 µm × 0.25-0.35 µm.

Due to the presence of fibrils and its own contraction, the bacterium is able to move. This ensures its rapid invasion into the human body during primary infection (usually during sexual contact). Treponema is able to maintain its pathogenicity after the infected biological fluid enters the environment, however, outside the living organism, the activity of bacteria does not last long (up to drying). When heated to 60 ° C, the pathogen lives for no more than a quarter of an hour. A temperature of 100 ° C provokes instant death of spirochetes.

The peculiarity of pale treponema is that this microorganism is able to multiply only in a narrow temperature corridor (about 37 ° C). This phenomenon formed the basis of pyrotherapy of the disease: an artificial increase in body temperature to 38-38.5 ° C causes the death of most pathogens.

Congenital syphilis develops as a result of the pathogen entering the fetus. Most often, infection occurs at 16-20 weeks of gestation, when the physiological formation of the placenta is completed.

A healthy placenta is a natural barrier to foreign agents entering the blood of the unborn child. In order for the pathogen of venereal pathology to penetrate into the baby's body, pathological changes occur in the tissue of the placenta. In this case, the infection spreads to the fetus in two ways:

• Treponema palidum is introduced through the umbilical vein (as an embolus);
• Spirochetes enter the baby's lymphatic system through slits in the umbilical cord.

The negative impact of a venereal infection on the body of a pregnant woman provokes the development of the following outcomes of the disease:

• late pregnancy termination (spontaneous abortion);
• premature birth;
• stillbirth;
• the birth of children with congenital syphilis (early, late).

According to most researchers, pathomorphological processes in the child's body are associated with the influence of germ cells on the genetic material. Among the syphilitic lesions, gametopathies are distinguished (changes in germ cells that occurred before the moment of fertilization), blastopathy (damaging effect on the embryo at the time of the first stages of division), embryopathies (effect on the fetus at 4-20 weeks of gestation).

Important! The highest risk of infection in a child whose mother during pregnancy suffers from a secondary form of syphilis.

Infection of the fetus is more likely if the mother has recently had a syphilitic infection. Over the years, the ability to become a source of infection decreases. However, medicine knows cases when infected children were born from a mother who suffered from a congenital syphilitic infection herself (in fact, the disease was inherited). However, such cases of hereditary syphilis in the second or third generation are more casuistry than a pattern.

Features of the classification

There are several classifications of the disease. In Russia, the division of syphilitic infection is accepted depending on its clinical and morphological manifestations and the time of onset of symptoms.

Placental injury

Defeat of a placenta at transplacental infection has primary character. When infected, it becomes enlarged, hypertrophied or hyperplastic, severe. Due to the violation of the elasticity of tissues, this organ of pregnancy looks flabby, easily torn. With syphilis, its mass can reach up to ⅓ of the weight of the fetus (at a rate of 15-20%).

Note! In more than half of the percent of cases, the detection of a heavy placenta on ultrasound indicates its syphilitic lesion.

To confirm the diagnosis, it is necessary to send biological material (a piece of placenta) for morphological examination. In this case, the cytologist will be able to determine the following pathological changes:

• puffiness;
• growing granulations;
• abscesses of the medial fibers of the villi;
• peri-endoarteritis;
• detection of pale treponemas.

Most of the degenerative-dystrophic lesions concern the germinal part of the placenta. The maternal side is affected less frequently and its changes are usually non-specific.

In addition, with the disease, changes occur in the structure of the umbilical cord (infiltration of leukocytes into the walls of arteries and veins). Also, a decrease in the volume of amniotic fluid is often observed.

Fetal syphilis

Early congenital syphilis often causes fetal pathologies. In the first months of pregnancy, the infection cannot be transmitted to the child, because active placental circulation not set up yet. However, pathological changes in the female reproductive system often cause malnutrition (malnutrition) and metabolic disorders in the fetus. In 60-70% of cases, this leads to fetal death and spontaneous abortion.

Starting from the 20th week of pregnancy, Treponema pallidum is able to penetrate the baby's circulatory system, causing specific pathological changes in the body. From this moment, it is possible to diagnose fetal syphilis in case of premature birth or stillbirth in the presence of specific signs:

• the size and weight of the fetus differ from the standard in a smaller direction;
• symptoms of maceration are observed (skin detachment in layers, pathological joint mobility, brain melting, skull collapse);
• widespread small cell infiltration of most internal organs;
• sclerotic tissue changes;
• detection in the internal organs of a significant number of spirochetes.

And what are the morphological changes in congenital syphilis: symptoms from the internal organs are presented in the table below.

Another target organ affected by congenital syphilis is the bones. A child in the V-VI month of intrauterine development develops specific osteochondritis or osteoperiostitis mainly in the growth zones located between the epiphysis and diaphysis.

Infection in the breasts

Early congenital syphilis in children under 12 months of age has other clinical manifestations. Signs of syphilis in a newborn and infant are associated with damage to all internal organs and systems. A sick child has a typical appearance:

• dry and wrinkled, like senile skin;
• areas of hyperpigmentation on the face and body;
• disproportionately large head with pronounced frontal tubercles;
• clearly visualized subcutaneous venous network;
• seborrheic crusts on the head;
• deeply sunken bridge of the nose;
• thin and elongated limbs;
• restlessness and disturbing sleep of the baby, frequent and loud cry;
• delayed psychomotor development;
• violations of the simplest unconditional acts (sucking, breathing, swallowing);
• severe dystrophy, low percentage of subcutaneous fat, bedsores.

Often, signs of congenital syphilis in newborns are accompanied by characteristic skin symptoms. Manifestations of syphilitic lesions of the epidermis are observed in 70% of cases.

Syphilitic pemphigus of the newborn is a symptom pathognomonic for the congenital form of the disease. It is determined immediately after the birth of the child or appears after a few days. It is characterized by the formation of blisters on the skin, which have several distinctive features. Firstly, they are located mainly on the palmar and plantar surfaces of the limbs, the face. Secondly, their size is relatively small, ranging from 5 to 10-15 mm. The blisters have a dense cover, a bright scarlet base, and inside them a transparent serous (less often hemorrhagic) fluid is produced, containing a large number of pathogens (spirochetes).

Formations in syphilitic pemphigus can spontaneously open. This leads to the exposure of infiltrated hyperemic erosion, which dries up after a few days with the formation of a brown-red crust.

Important! Newborns and infants with congenital syphilis without treatment die within 5-8 months.

Signs of illness in preschoolers

Symptoms of congenital syphilis in children under 4 years of age are mild. Usually not the whole body is affected, but two or three separate systems. Skin manifestations are considered specific:

• weeping large papular rashes on the skin of the inguinal region, perineum, natural folds, less often on the face and scalp;
• erosive warts, merging with each other;
• pustules with an eroded nodule in the center, localized mainly on the mucous membrane of the gums, tonsils, tongue, and also in the corners of the mouth.

In addition, this form of the disease is characterized by the appearance of signs of syphilitic laryngitis (hoarseness, sore throat), rhinitis (atrophic runny nose, sometimes destruction of the vomer and nasal septum), baldness, lymphadenitis, lesions of the musculoskeletal system (periostitis of the fingers, phalangitis) .

Damage to the central nervous system is accompanied by a lag in the child's mental and motor development, convulsive seizures, hydrocephalus, and sluggish inflammation of the meninges. Often the disease proceeds with pathomorphological changes in the organ of vision (optic nerve atrophy and blindness, keratitis and choreoritinitis).

Important! Diagnosis of the congenital form of infection in early childhood is usually not difficult, since standard serological tests in such patients are sharply positive.

Late syphilitic lesion

Clinical signs of this form manifest themselves no earlier than 4-5 years of a child's life. According to statistics, most patients experience symptoms of this form at the age of 14-15 years.

In many children with a late course of the pathology, signs of an early form of the disease are asymptomatic. Others show typical pathomorphological changes (deformation of the brain or facial skull, saddle-shaped nose).

In general, the clinical picture of the disease does not differ from tertiary syphilis. In children and adolescents, multiple multiple organ disorders, visceropathy, diseases of the nervous system and endocrine glands are observed.

Specific symptoms that reliably indicate a congenital syphilitic lesion that has developed in a child include:

• parenchymal keratitis (pronounced clouding of the cornea, lacrimation, photophobia);
• dental dystrophy (hypoplasia of the incisors, the presence of sickle-shaped and semilunar recesses on the molars);
• labyrinthitis (deafness caused by degenerative lesions of both auditory nerves).

Possible signs of a late infection include gonitis (chronic inflammation of the knee joints), periostitis and osteoperiostitis, "saber" shins, saddle nose (significant protrusion of the nostrils forward due to deformation of the bones of the skull), buttock-shaped skull, dystrophy of molars, various lesions of the nervous system (mental retardation, dysarthria, hemiparesis, and Jacksonian epilepsy).

In addition, the so-called stigmas can indicate a late congenital form of a sexually transmitted disease - signs of a degenerative lesion of the intrasecretory, nervous and of cardio-vascular system. Among them are:

• "Gothic" palate;
• changes in the structure of the facial and cerebral skull - intensely protruding forward tubercles in the frontal and parietal sections;
• additional protrusion on the inner-lateral surface of the teeth of the molars (tubercle of Carabelli);
• axifoidia - underdevelopment of the xiphoid process of the sternum;
• shortening of the little finger.

Often in babies with congenital syphilis, a symptom such as hypertrichosis is observed. It can develop in both boys and girls, and from a very young age. It is characterized by excessive hair growth of the skin of the extremities, chest, back, buttocks. Often there is a complete overgrowth of hair on the forehead, cheeks, chin.

Diagnostic principles

In the diagnosis of the congenital form of infection, knowledge of the clinical and pathomorphological features of the disease plays an important role. To confirm the doctor's guesses, standard serological tests are usually used, which are effective in 100% of cases with an early form of the disease, and in 90-92% of cases with a late one.

In addition to laboratory tests, the following are of great diagnostic value:

• lumbar puncture (in the presence of neurological symptoms);
• R-graphy of bones and joints;
• expert advice:
  • pediatrician;
  • ophthalmologist;
  • ENT doctor;
  • neuropathologist;
  • infectiologist.

During the diagnosis of infection in a child, it is important to simultaneously examine his mother and other close relatives. At the same time, blood sampling from a woman 2 weeks before and 2 weeks after childbirth is not recommended due to insufficient information content of the results. For high diagnostic value, the serological examination of a woman and a newborn should be comprehensive and include the Wasserman reaction, RIBT and RIF.

Note! For examination of older children and adolescents with suspected congenital syphilis RIF (immunofluorescence reaction) or RIBT (treponema pallidum immobilization reaction) should be used. They show a positive result in almost all patients.

Current approaches to therapy

Treponema pallidum is a unique microorganism despite long history the use of penicillins, which retained high sensitivity to antibiotics of this group. Therefore, the main method of antimicrobial therapy for syphilis remains the long-term and systematic administration of therapeutic doses of penicillin derivatives:

• water-soluble - benzylpenicillin (potassium, sodium salt);
• medium duration - novocaine salt of benzylpenicillin, Bicillin, Procainepenicillin;
• high duration - BBP (dibenzylethylenediamine salt of benzylpenicillin).

The preferred method of maintaining a constant therapeutic concentration of an antibiotic in the body is its regular intravenous or intramuscular administration. When taken orally, the drug is absorbed into the blood much worse. If a child is diagnosed with a syphilitic lesion of the nervous system, injections of the drug should be combined with its endolumbar administration, as well as pyrotherapy (creating artificial hyperthermia), which improves the passage of penicillins through the blood-brain barrier.

If a child is intolerant to penicillin antibiotics or has a history of allergic reactions, alternative treatment regimens with Erythromycin and other macrolides, as well as tetracycline derivatives, are used. The use of cephalosporins is not recommended due to possible cases of cross-allergy. Also contraindicated for monotherapy are aminoglycosides (effective against treponema pallidum only in very high doses that are toxic to the child) and sulfonamides (the pathogen shows high resistance in their respect).

The prognosis of the disease is largely determined by the timeliness of treatment for medical care. Early screening diagnosis of venereal pathology in a pregnant woman makes it possible to prevent infection of the fetus, and the treatment of congenital syphilis with effective antibiotics significantly reduces the risk of complications.

Due to the intensive course of antimicrobial therapy, most children with congenital syphilis recover completely by the end of the first year of life. However, neglected damage to most internal organs in the late form of the disease can have serious health consequences.

Prevention measures

The medical examination system, actively developed by WHO at the end of the 20th century, made it possible to significantly reduce the number of cases of registration of patients with congenital syphilis. They played a big role in this:

• mandatory registration of all patients with syphilis (special attention is paid to women of reproductive age);
• early detection and timely initiation of treatment of persons-sources of infection;
• therapy based on the principles of a guaranteed volume of free and high-quality medical care;
• two- or three-time prophylactic for all expectant mothers, as well as employees Food Industry, DDU;
• close connection in the work of LCDs, maternity hospitals, pediatric departments of polyclinics and dermatovenerological dispensaries.

Laboratory diagnosis of syphilis in pregnant women is carried out at the beginning (at the time of registration in the antenatal clinic) and at the end (for a period of 30-32 weeks) of pregnancy. If, during the examination, this venereal infection in an active or latent form was detected in the expectant mother, she is prescribed a full course of antimicrobial therapy. If a history of syphilis is indicated, the woman is also undergoing prophylactic antibiotic treatment, even if she has already successfully completed therapy. Injections of penicillin derivatives in this case are necessary to prevent the recurrence of the disease and the birth of a healthy baby.

Important! Children born to mothers who have been infected with treponema pallidum should be under dispensary observation. medical workers until they reach the age of 15. This will allow them to be diagnosed as early as possible with signs of early and late congenital syphilis in the event of its development.

When positive result serological tests during pregnancy, two weeks after birth, the diagnosis of syphilis in the mother is repeated. It is also necessary to carefully examine the newborn. In the event that a venereal infection is detected, both should begin a course of antisyphilitic treatment as early as possible.

Thus, the prevention of congenital syphilis consists not only in preventing the development of infection through health education among people of reproductive age, promotion of protected sex and the use of condoms, but also in the early detection of a sexually transmitted disease in a pregnant woman. Timely seeking medical help will prevent the development of serious irreversible changes in the body of the fetus and will allow you to give birth to a strong and healthy child.

27.06.2017

Congenital syphilis is a clinical form of the disease that occurs when a fetus is infected during fetal development.

This is possible if the mother is infected with pale treponema.

The disease can manifest itself in different periods of a child's life: from infancy to adolescence. Infection in infancy is extremely dangerous because it can cause irreparable damage to the baby's unstable immune system.

A characteristic feature of the lesion is the manifestation of syphilitic rashes on the skin and mucous membranes, deformation of the bones and lesions of the internal organs of the somatic and nervous system.

Detection of the disease is based on obtaining a positive reaction to a specific sample, but patients should be aware that the laboratory method should not be the method of examination used, this is due to high risk obtaining a false negative or false positive result.

The danger of error lies in the wrong choice of methods of therapeutic action. To eliminate the manifestations of the disease, antibacterial agents, bismuth-based drugs and agents to increase immune functions are used.

The list of common sexually transmitted diseases, along with chlamydia and gonorrhea, includes syphilis, the causative agent of which is pale treponema. This microorganism is transmitted not only sexually, a possible way of infection - intrauterine is the most dangerous.

Infection occurs while the fetus is in the womb. The microorganism provokes the manifestation of congenital syphilis in a baby, making it potentially dangerous for the surrounding member of society if the disease proceeds with complications in the form of lesions on the skin.

Early congenital syphilis is manifested as a result of the passage of pale treponema through the placenta from an infected mother to the child. That is why gynecologists pay special attention to the analysis of syphilis in pregnant women, blood tests are carried out at least 3 times during pregnancy.

The first time a woman donates blood at registration (up to 12 weeks), later in the 2nd and 3rd trimester. It is important to remember that infection, provided that the mother is infected with the virus, can occur at different stages of fetal development, the infection passes to the baby through the lymphatic crevices of the umbilical vessels.

The entry of a microorganism and the deformation of the organs and tissues of the fetus begins from the moment of transition to the placental circulation. This moment falls on 4-5 months of gestation, therefore only a timely examination of women will help give birth to a healthy baby.

Attention! The statistics are frightening, more than 90% of babies die in utero or die during the first days of life if the mother has not been treated or has not received a full course of therapy.

Summary data regarding disability due to the diagnosis of congenital syphilis is not comforting. Despite the confident steps of medicine in the treatment of this complex disease, pick up necessary treatment in relation to the child at the moment is difficult.

The greatest risk of infection of the baby on prenatal stage observed in the first few years of maternal syphilis. If the mother is secondarily infected, the risk reaches 100%. After a few years, this ability is significantly weakened.

Fact! Cases of the birth of infected children from mothers with primary syphilis are exceptional.

Among the list of dangerous consequences of syphilis for a pregnant mother and fetus, there are:

• abortion;
• spontaneous interruption of the natural course of pregnancy;
• premature birth;
• intrauterine fetal death;
• stillbirth;
• death of a newborn;
• the birth of a child with a latent form of the disease.

Another outcome is also possible - the birth of a healthy child. But the data is disappointing, 12% of mothers manage to experience such luck. In most cases, this effect is achieved through timely medical intervention.

The danger of the disease primarily lies in the inadequate thinking of modern man about venereal diseases. Pathologies of this kind are considered something disgusting and unacceptable. However, no one is immune from meeting with such diseases, and the expectant mother should not pay attention to judgmental looks, but pass complete treatment in the hope of saving the life of the fetus.

Main types

The basic principle of the classification of congenital syphilis is based on the stages of manifestation of the disease in a child. The possible range of manifestation of the first signs varies significantly: from infancy to puberty.

Variations in the possible outcome of the disease largely depend on the timeliness of the detection of the disease. The sooner the first signs are noticed, the better.

In medical practice, the following forms are diagnosed:

1. Early congenital syphilis is called fetal syphilis. In this case, infection occurs at the intrauterine stage. If the pathology was detected in the second trimester of pregnancy, there is a risk of premature termination of pregnancy. You need to pay attention to the fact that the cause of miscarriage at 5-6 months of pregnancy is often STDs.
2. Syphilis in infancy. It is possible if the infection of the mother occurred in the last stages of gestation. The difficulty lies in the fact that the Wesserman reaction is informative only from the 3rd month of the baby's life.
3. Syphilis of early childhood is diagnosed if the disease manifested itself between the ages of 1 and 4 years.
4. Late congenital syphilis is diagnosed at puberty, while it does not manifest itself until a certain stage. The danger for an imperfect organism is that it is a recurrence of a dangerous and undiagnosed pathology.
5. Latent congenital syphilis - manifests itself in a child at any age, while it proceeds in a latent form up to a certain stage. The Wessermann reaction in this case may be false negative. only possible method detection is a serological test, the material used is cerebrospinal fluid.

The course of the disease in a latent form allows the child to live up to a certain point. Such a member of society will be no different from others and will live normal life. It is important to remember that all forms of syphilis are dangerous and can cause disability or death.

early syphilis

In the case of infection at the intrauterine stage of a living child, the diagnosis is determined - syphilis of infancy. It is found in babies whose age is up to a year.

The period of violence of the microorganism proceeds in two stages:

1. Up to 3-4 months. Dermatological defects appear on the mucous membranes and skin. Significant lesions of internal organs (liver, spleen and nervous system) are diagnosed.
2. Starting from 4 months. The main symptoms of the disease subside. Separate rashes appear on the skin, gummas form in the bones. Damage to the central nervous system and other internal organs is diagnosed less frequently.

Manifestations of the disease can be fixed at the time of the first 2 months. It is important to note that they are extremely contagious.

In recent decades, syphilis has been diagnosed in children, which occurs in a latent form, this is primarily due to the use of antibacterial drugs.

Symptoms of early congenital syphilis include:

• pemphigus;
• skin infiltration;
• syphilitic rhinitis;
• osteochondritis;
• hydrocephalus;
• periostitis;
• meningitis.

Such patients gain weight slowly, lag behind their peers in development, are more restless (often cry) and sleep poorly.

Late congenital syphilis

A clear symptomatic picture of late congenital syphilis appears in the age range from 1 to 15 years. Symptoms may appear in the third year of life, but most often the disease makes itself felt in adolescence.

Late congenital syphilis is characterized by the formation of gums, tubercles and scars on the skin and mucous membranes. Diseases of the endocrine system are often manifested. This happens due to a decrease in immunity and hormonal changes.

Among the list of clinical manifestations characteristic of the disease, there are:

• diffuse thickening of the liver;
• manifestation of gummous nodes;
• damage to the spleen;
• nephrosis;
• insufficiency of heart valves;
• endocarditis;
• myoarditis;
• lung damage;
• diseases of the digestive tract;
• damage to the organs of the endocrine system.

Attention! If a woman suffers from a chronic form of syphilis, the birth of a healthy baby is likely, therefore the symptoms of the disease should not be neglected, the diagnosis of syphilis is not a sentence for the conception and birth of a healthy baby.

Characteristic symptoms

A woman infected with syphilis has a chance of having a healthy baby. In order not to miss such an opportunity, attention should be paid to timely diagnosis, medical testing should not be neglected.

Symptoms of pathologists are largely diverse, but they completely depend on the type of disease.

Among the list of symptoms of congenital syphilis of the fetus, there are:

• significant size of the fetus in combination with a small body weight;
• swelling and friability of the skin;
• atrophy of the liver or its deformation;
• seals in the spleen;
• ulceration in the stomach;
• brain damage.

Symptoms of congenital syphilis of the thoracic period include:

1. Dry skin of the face, the appearance of wrinkles.
2. An increase in the size of the head, the manifestation of a venous network on the forehead and seborrheic formations in the hairy areas.
3. Retraction of the bridge of the nose.
4. Unhealthy skin color, from icteric to dirty green.
5. Rapid weight loss, thin limbs, developmental delay from peers.
6. Inability to grasp the nipple, which occurs against the background of persistent rhinitis.
7. Manifestation of syphilitic pemphigus.
8. Redness of the heels.
9. Diffuse formations on the skin.
10. Syphilitic alopecia.
11. Damage to the eyes and joints.

Among characteristic features syphilis of early age is isolated:

• the formation of weeping papules in the genital area;
• non-healing seizures in the corners of the mouth;
• syphilitic rhinitis;
• alopecia;
• enlarged lymph nodes;
• damage to bone tissue;
• impaired renal function;
• damage to the nervous system that provokes mental retardation;
• optic atrophy.

The clinical symptoms of congenital syphilis go unnoticed extremely rarely, that is, this is possible only in cases where the disease occurs in a latent form. Damage to the internal organs is manifested by swiftness, especially in infants.

Attention! If therapeutic measures are not taken in a timely manner regarding the treatment hidden form syphilis, in adulthood, the baby will become a carrier of pale treponema and become a source of the microorganism for other people.

Signs of the disease are difficult to confuse with deviations of a different nature, because a woman learns about the risk of infection of the fetus during pregnancy. It is important for parents to familiarize themselves with the main signs of the disease, to learn diagnostic methods that help determine or refute the presence of pale treponema.

Diagnostic measures

The disease can be detected in the mother at any stage of pregnancy.

Various methods are used to confirm or refute the diagnosis in a child at the prenatal stage of development, including:

1. X-ray examination. The technique allows you to timely confirm or refute the presence of periosteal deformities or inflammation of the bones.
2. Serological reactions involve the introduction of an antigen into the blood and study the reaction of the body.
3. RIBT.
4. REEF.

It is necessary to examine the child with the following specialists:

• neuropathologist;
• ophthalmologist;
• otolaryngologist;
• pediatrician;
• cardiologist;
• gynecologist (for girls).

Provided that therapeutic measures are taken in a timely manner, proper care and completion of the full course of therapy, the outcome for the child can be favorable.

Complications of syphilis

Congenital syphilis, the symptoms of which can be frightening, often manifest themselves at different periods of life. Predictions for the outcome of pathology in this case can be very diverse. The death of a child is possible even in the neonatal period or a complete recovery after undergoing a course of therapy.

Even during pregnancy, there are many dangers for an infected mother. It is simply impossible to predict the possible outcome of pregnancy with accuracy.

Modern methods of complete treatment suggest:

• careful care of the baby;
• replacing the breast milk of an infected mother with an adapted formula;
• consumption necessary drugs and vitamin complexes.

It is extremely important to remember the main condition - the earlier the pathology is detected, the higher the chances of success. With congenital syphilis, timely diagnosis plays a huge role.

Early congenital syphilis can be cured, for this you need to follow all the requirements of the doctor.

Therapy Methods

If the signs of congenital syphilis are identified in a timely manner, and the drugs for its treatment are selected correctly, then the treatment will most likely give a positive result.

Drug therapy involves a mixture of several groups of drugs, the action of which is aimed at improving the patient's condition:

1. Reception of a complex of vitamins.
2. The introduction of antibiotics of the penicillin group.
3. Bismuth preparations.
4. When allergic to penicillin, antibacterial agents of other groups are used.
5. The use of biogenic stimulants.
6. The use of immunomodulators.

Treatment involves proper care:

• skin care;
• compliance with the rules of breastfeeding;
• diet control;
• compliance with sleep and wakefulness;
• establishment of a drinking regime;
• daily walks in the fresh air;
• spa therapy;
• stay under the supervision of specialists.

Attention! Treatment of syphilis, regardless of form and stage pathological process occurs in a hospital venereology department.

Preventive actions

If an infection in a pregnant woman was detected before the 5th month of pregnancy, effective prevention of the disease is possible, since pathological changes in tissues and organs do not occur in the early stages. After completing the full course of drug exposure, there is no threat to the fetus.

Diagnostic manipulations make it possible to identify the disease at the prenatal stage and carry out treatment that minimizes existing risks for the fetus.

Women should remember that sexually transmitted diseases are treated if they see a doctor in a timely manner.

You should not feel embarrassed at the time of passing the diagnostic test, because only these measures will allow you to maintain your own health and give birth to a baby.

The use of barrier methods of contraception can reduce the risk of infection entering the body, but 100% protection is still impossible.

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