2. Introduction Infant usually infected in utero by transplacental passage of Treponema pallidum from infected mother at any time. Infection may also occur from contact with an infectious lesion during passage through the birth canal It remains unclear what factors determine which mothers, particularly those in the latent stage, will pass the disease to the fetuses. Also unclear why some infants, infected in utero, are born asymptomatic, but develop overt dz. In first few wks./mo.
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5. Pathogenesis Infection before 4 th month of pregnancy? Possible that treponemes do in fact pass from mother to fetus before 5 th month of gestation, but classic pathologic changes do not occur until after 5 th month. Infection involves the placenta, and spreads hematogenously to the fetus, widespread involvement is characteristic. Infected placenta is paler, thicker, and larger than normal.
20. Infant Testing Reactive serology in neonate could be due to IgG passively transferred to newborn through placenta, and does not indicate active infection. If infant’s titer higher than mother’s congenital infection If decreasing titer in infant passive transfer of antibodies, should disappear by 3-4 months of age. Persistently reactive VDRL, with rising titer Active Infection
21. Recommended Interpretation Non-treponemal Test ( VDRL, RPR, EIA, ART) Treponemal Test (MHA-TP, FTA -ABS) Mother Infant Mother Infant Interpretation - - - - No syphilis or incubating syphilis in the mother and infant. + + - - No syphilis in mother (false-positive non-treponemal test with passive transfer to infant). + +/- + + Maternal syphilis with possible infant infection; or mother treated for syphilis during pregnancy; or mother with latent syphilis and possible infection of infant. + + + + Recent or previous syphilis in the mother; possible infection in the infant. - - + + Mother successfully treated for syphilis before or early in pregnancy; or mother with Lyme disease, yaws, or pinta (ie, false-positive serology).
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24. Treatment Proven or highly probable: Aqueous crystalline Penicillin G 100,000-150,000U/kg/day (given q8-q12hrs) IV for 10 days OR Procaine Penicillin G 50,000 U/kg/day IM for 10days If >1 day of therapy missed, entire course should be restarted!
25. Treatment Asymptomatic, Normal CSF exam, CBC, platelets, and Radiologic exam: 1. No maternal tx aqueous PCN G IV for 10-14 days 2. Tx w/ Erythromycin clinical, serologic follow-up, and Benzathine Pcn G IM x 1 3. Tx < 1month before Delivery, or <4 fold Decrease in titers clinical, serologic follow-up and Benzathine Pcn G IM x 1
