Congenital Syphilis Diagnosis

Congenital Syphilis Diagnosis & Treatment (CDC)
Definitive diagnosis:
1. By direct visualization of spirochetes using darkfield microscopy
2. Or direct fluorescent antibody tests of lesion exudate or tissue (Placenta/UC)
Presumptive diagnosis can be made using
- Nontreponemal ( False + in medical conditions)
- Treponemal (False+ in other spirochetal Diseases)
→ So use of only one type is insufficient
- If nontreponemal test is +→ confirmatory testing is performed with a specific
treponemal test
Nontreponemal test:
• VDRL (Venereal Disease Research Laboratory)
• RPR (Rapid plasma reagin)
• ART (Automated reagin test)
Used for screening (sensitive but not specific)
- Inexpensive, performed rapidly, and provide quantitative results
→ helpful indicators of disease activity & monitor treatment response
- Measures Ab directed against lipoidal Ag from T. Pallidum, Ab interaction with host
tissues or both
- Nonspecific Ab develop 4-8 weeks following infection
• False negative
- Early primary S
- Latent acquired S
- Late CS
- Prozone phenomenon

• False Positive
- Viral infection ( EBV, Hepatitis, Varicela, Measles)
- Lymphoma
- TB
- Malaria
- Endocarditis
- CT diseases
- Pregnancy
- IV drugs
- Wharton Jelly contamination in cord samples

Treponemal Specific Test
• T pallidum immobilization (TPI)
• Fluorescent treponemal antibody absorption (FTA-ABS)
• Microhemagglutination assay for antibodies to T pallidum (MHA-TP)
• Confirm + nontreponemal reaginic test
• Remain positive for life
i.e. Result do not correlate with disease activity and tests are not quantified
• False + reactions:
→ Other spirochetal diseases (e.g., yaws, pinta, leptospirosis, rat-bite fever, relapsing
fever, Lyme disease





Other Tests Results For Congenital Syphilis
CBC : Anemia, leukositosi/penia, ↑PT
Fungsi hati : ↑ALP, ↑OT/PT
CXR : Pneumonia Alba (Fluffy diffuse infiltrate)
Long bone radiography : Multiple sites of osteochondritis at wrists, elbows, ankles and
knees and periostitis of long bones
MRI : cerebral hypertrophy and hyperintensity in the temporal
lobes
CDC Newborn Evaluation :
• A presumptive diagnosis, which results in tx, is made if baby has + serologic test
and any of following:
1. Compatible findings on P/E
2. CSF abn. (+ VDRL, ↑ WBC, or ↑protein)
3. Osteitis on x-ray long bones
4. Placentitis
5. NT test 4x > than maternal
6. Positive FTA-ABS-19S IgM antibody

Indications for Penicilin Treatment in Newborn:
1. If newborn meets any of criteria
2. If mother was treated < 4 weeks prior to delivery
3. If mother treated with other than penicillin
4. If maternal titers suggest inadequate response to treatment before or early in
pregnancy



Treatment :
• IV Penicillin G is the drug of choice for all stages of syphilis including CS
• Infants:
- 100,000 - 150,000 U/kg/d IV Q12 x 7 d. then Q 8 to complete 10 days
- Or Procaine Penicillin G 50,000 U/kg/d IM once for 10 days (adequate CSF conc. may not be
achieved)
Prognosis :
Infected early in pregnancy ➨ stillborn
• Treatment of expectant mother ↓ risk of CS
• Babies who become infected when passing through birth canal have better outlook
• Death from CS is usually through pulmonary hemorrhage

Syphilis in Pregnancy:
• Screen pregnant women at least at first prenatal visit.
– In high prevalence communities or patients at risk:
• Test twice during the third trimester, at 28 weeks and at
delivery, in addition to routine early screening.
• Any woman who delivers a stillborn infant after 20 weeks gestation should be tested
for syphilis.
• Treat all pregnant patients with penicillin, regardless of the stage of pregnancy
• 3 doses of benzathine penicillin (2.4 million U IM at 1-week intervals)
• Serologic titers should be repeated at 28–32 weeks’ gestation and at delivery as
recommended for the disease stage.
No proven alternative treatment for patient allergic to penicillin
i.e. Erythromycin for patient allergic to penicillin is not reliable treatment for fetus


Differential Diagnosis For Syphilis (Kulit FKUI)
SI
 Herpes simpleks
 Ulkus piogenik
 Skabies
 Balanitis
 LGV
 Squamous Cell Ca
 Penyakit Behcet
 Chancroid (Ulkus Mole)

SII
 Erupsi obat alergik
 Morbili
 Pitiriasis rosea
 Psoriasis
 Dermatitis seboroik
 Kondiloma akuminatum
 Alopesia areata

SIII
 TB
 Frambusia
 Mikosis profunda (Sporotrikosis & Aktinomikosis)