Syphilis and pregnancy

FrequentVariable, 1.5 - 2.5%. The importance of this condition is in decline with decreasing frequency, therapeutic efficiency and improve prognosis.
 Syphilis breast, diagnosed and treated outside of pregnancy, there is no danger to subsequent pregnancies. Under increased incidence of infection and decrease the quality of prenatal consultation, congenital syphilis can be a real problem.
 The influence of pregnancy on syphilis.
 During primary incubation can be reduced to 10-12 days. Efflorescent chancre and is accompanied by edema. Evolution, in the absence of treatment may be extended to term. If located on the cervix can become a cause of distogie.
 During all genital lesions secondary, bucofaringiene, skin and Florida have an evolution accompanied by general signs: fever, headache, osteoarticular, lymph nodes.
 During tertiary diagnosis is serological.To cross the placenta, Treponema must be present in maternal blood. Therefore, ingectiile untreated primary and secondary is the biggest risk of fatal infection.
Influence of syphilis on pregnancy.
 Because trophoblastic thickness vilozitar Treponema pallidum crosses the placenta during the first months. As maternal contamination occurs later in the pregnancy, the greater the risk that the infant was infected with evolving forms of Treponema. Although, as noted, placental passage is not before 16 weeks, and note the view that fetal infection may occur in the first quarter. In these conditions, serological tests and treatments during the first quarter rutiniene can prevent many fatal infections. It takes the quality of prenatal consultation.
Share syphilis in the etiology of spontaneous abortion is only 5% (of total abortions).This type of abortion occurs in the fifth and sixth months, preceded by a period of retention and is accompanied by reduced bleeding.
Premature birth is possible. Death in utero may occur in virulent forms (25% of cases).
Infant may present specific lesions more or less serious: palmar-plantar pemphigus, the most characteristic skin lesion present at birth or during the first two days, labial mucosa lesions in the nostrils or anal lesions hepatomatice visceral type,splenomegaly, ascites, bone lesions or meningeal.
Visceral lesions (hepatomegaly or splenomegaly) call frequently isolated and found to be systematically in newborns of mothers Lueta. Their presence signifies a poor prognosis (mortality without treatment is 20-50%).The child may be born apparently healthy.Negative serology (cord blood) is not evidence of absence of contamination (also positive reaction is not without errors). For these reasons, testing should be repeated.Weight unfavorable evolution of the newborn can be element of suspicion of infection.In the first weeks repetete bone radiographs necessary in cases where it is suspected congenital syphilis (lower epiphyseal radius, ulna, femur and upper tibia).
The role of syphilis in the genesis of congenital malformations is not accepted.Syphilis can cause chronic polihidramniosul. Annexes fetal lesions are not specific.Placenta may be hypertrophied, swollen, pale, brittle, damaged by endarterita obliterans. Cord shows nodule, arthritis or phlebitis.Diagnosis.
 Serozitatile sampling from the chancre or secondary skin lesions allow direct examination, ultramicroscopical with Treponema decelarii possibility.
Serological diagnosis (Bordet-Wassermann, Venera Diseases Research Laboratory, Treponema Pallidum Hemaglutination Assay) is accomplished by the two binding reactions during pregnancy outcome.
Treatment.Before conception, treatment should be made by both partners, procreation is authorized only one year to heal.
During pregnancy, if recent syphilis, the treatment requires intense and prolonged as possible before you smooth.
 Penicillin V begins: half a tablet on the first day, one pill the second day, two tablets three to four days, from the fifth day Moldamin manages 1.2 million to three days, total dose was 12 million, a break in sequence two months is given a second course of treatment.
Can be used penicillins retardation: extencilina, 2-4 million units, repeated after eight days biclinocilina one million units per day, 15 days flocilina 600 000 units a day for 15 days. Is also given two courses (the first as early as the second end of the sixth).
The newborn treatment is carried out only if there are signs of syphilis congenital.Doza total is 200 000 units penicillin per kg, 10 to 30 000 units per day.