Bl. Mcfarlin et al., EPIDEMIC SYPHILIS - MATERNAL FACTORS ASSOCIATED WITH CONGENITAL INFECTION, American journal of obstetrics and gynecology, 170(2), 1994, pp. 535-540
OBJECTIVE: Little is known about which cases of maternal syphilis will
affect the newborn. Because of the current epidemic of syphilis in pr
egnancy in our city, we sought to identify risk factors during pregnan
cy associated with congenital infection. STUDY DESIGN: We reviewed 253
cases of maternal syphilis prospectively identified over a 1-year per
iod. On the basis of neonatal diagnosis, these data were divided into
two groups, those without evidence of presumptive congenital syphilis
and those with evidence of presumptive congenital syphilis. Presumptiv
e congenital syphilis was defined according to the Centers for Disease
Control and Prevention surveillance case definition. Cases with blood
y spinal taps and cases of suspected congenital syphilis that did not
meet these criteria were excluded. Venereal Disease Research Laborator
y titers are given as the inverse of the geometric mean. RESULTS: Vene
real Disease Research Laboratory titer at time of diagnosis and unknow
n duration of disease were risk factors for congenital syphilis. There
was a significantly decreased rate of congenital syphilis with single
-dose therapy if disease length was < 1 year (p < 0.005). Unknown dura
tion of disease was associated with 67.9% and 48.6% Fates of congenita
l syphilis with one- and three-dose therapy respectively. There was a
28% incidence of preterm birth. CONCLUSION: Our study suggests an alar
ming rate of failure of current therapy to prevent congenital syphilis
. Venereal Disease Research Laboratory titer at time of diagnosis and
unknown duration of disease are risk factors for congenital syphilis.
The high rate of presumptive congenital syphilis in the unknown durati
on group indicates that identification before or earlier in pregnancy
wilt be necessary to prevent devastating consequences for the neonate.