Abnormal Development - Syphilis

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Introduction

The spirochete bacteria treponema pallidum, the cause of syphillis.

The variety of bacterial infections that can occur during pregnancy is as variable as the potential developmental effects, from virtually insignificant to major developmental, abortive or fatal in outcome. Some bacteria are common and are part of the normal genital tract flora (Lactobacillus sp), while other bacterial infections are less common or even rare and initially infect/transmit by air or fluids through the different epithelia (genital tract, lungs, gastrointestinal tract). The genitally transmitted common sexually transmitted diseases (STDs) are the bacterial infections described as syphilis and gonorrhoea.


In the USA before 1989, reported cases of congenital syphilis (CS) were defined and classified on the basis of a set of clinical and serologic features known as the "Kaufman criteria". In 1988, the CDC developed a new surveillance case definition "All infants born to mothers who have untreated or inadequately treated syphilis are considered potentially infected. (This criterion is based on the 70%-100% chance that during the first 4 years of infection, an untreated woman will transmit syphilis to her unborn baby)."[1]


Bacterial Links: bacterial infection | syphilis | gonorrhea | tuberculosis | listeria | salmonella | TORCH | Environmental | Category:Bacteria


Environmental Links: Introduction | low folic acid | iodine deficiency | Nutrition | Drugs | Australian Drug Categories | USA Drug Categories | thalidomide | herbal drugs | Illegal Drugs | smoking | Fetal Alcohol Syndrome | TORCH | viral infection | bacterial infection | fungal infection | Zoonotic Infection | Toxoplasmosis | Malaria | Maternal Diabetes | Maternal Hypertension | maternal hyperthermia | Maternal Inflammation | Maternal Obesity | Hypoxia | Biological Toxins | chemicals | heavy metals | air pollution | radiation | Prenatal Diagnosis | Neonatal Diagnosis | International Classification of Diseases | Fetal Origins Hypothesis

Some Recent Findings

  • Progression of ultrasound findings of fetal syphilis after maternal treatment[2] "The purpose of this study was to evaluate ultrasound findings of fetal syphilis and to describe their progression after maternal treatment. ...Sonographic signs of fetal syphilis confer a higher risk of congenital syphilis at delivery for all maternal stages. Hepatomegaly develops early and resolves last after antepartum treatment."
  • Review - Strategies of testing for syphilis during pregnancy[3] "Each year about two million pregnant women are infected with preventable syphilis infection, mostly in developing countries. Despite the expansion of antenatal syphilis screening programmes over the past few decades, syphilis continues to be a major public health concern in developing countries. Point-of-care syphilis testing may be a useful strategy to substantially prevent syphilis-associated perinatal mortality and other negative consequences in resource-poor settings. However, the evidence on effectiveness has been generated mostly from observational study designs or has been reported as a mixed-intervention effect."
  • Lives Saved Tool supplement detection and treatment of syphilis in pregnancy to reduce syphilis related stillbirths and neonatal mortality[4] "This review sought to estimate the effect of detection and treatment of active syphilis in pregnancy with at least 2.4 MU benzathine penicillin (or equivalent) on syphilis-related stillbirths and neonatal mortality. ....Moderate quality evidence (3 studies) supports a reduction in the incidence of clinical congenital syphilis of 97% (95% c.i 93 – 98%) with detection and treatment of women with active syphilis in pregnancy with at least 2.4MU penicillin."
  • Maternal and congenital syphilis in Shanghai, China, 2002 to 2006.[5] "A total of 535,537 pregnant women were included in the analysis. During this period of time, 1471 maternal syphilis cases (298.7 per 100 000 live births) and 334 congenital syphilis cases (62.4 per 100,000 live births) were identified. Both maternal and congenital syphilis rates increased from 2002 until 2005, with a slight decrease in 2006. The rate of maternal syphilis was 156.2 per 100,000 live births in Shanghai residents and 371.7 per 100,000 live births in the migrating population (p<0.001). The compliance to treatment for maternal syphilis was poorer in women with a lower level of education. The rate of congenital syphilis in infants born to mothers with incomplete treatment (50.8%) was much higher than in infants born to mothers with complete treatment (12.5%). Rates of fetal death, neonatal death, and major birth defects were 30.4%, 11.0%, and 3.8%, respectively, in the incomplete treatment group; the corresponding figures were 5.5%, 0.56%, and 0.46%, respectively, in the complete treatment group. Infant outcome was also affected by initial maternal RPR antibody level and time of treatment, with much better outcomes in mothers with low antibody levels and earlier treatment. There has been a resurgence of congenital syphilis in Shanghai, China, especially in the migrating population and other populations with a lower socioeconomic status." (More? China Statistics)
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Search term: Abnormal Development Syphilis

<pubmed limit=5>Abnormal Development Syphilis</pubmed>

Treponema Pallidum

Treponema-pallidum.jpg
Treponema pallidum (scanning EM, Image CDC)
  • The bacterium Treponema pallidum (T. pallidum) causes syphilis and congenital syphilis.
  • syphilis is a sexually transmitted disease (STD).
  • a gram-negative spirochete
  • helical-shaped bacteria
  • cannot be cultured on artificial media
  • circular DNA containing about 1.1 million nucleotides encoding about 1,000 genes.

Lineage

  • Bacteria; Spirochaetes; Spirochaetes (class); Spirochaetales; Spirochaetaceae; Treponema; Treponema pallidum; Treponema pallidum subsp. pallidum;
    • Treponema pallidum subsp. pallidum SS14
    • Treponema pallidum subsp. pallidum str. Nichols

Congenital Syphilis

The following information is based upon the 2003 CDC Surveillance Case Definition for Congenital Syphilis.[1]

Confirmed case

Congenital syphilis is an infant or child in whom Treponema pallidum is identified by darkfield microscopy, direct fluorescent antibody, or other specific stains in specimens from lesions, placenta, umbilical cord, or autopsy material.

Presumptive case

Congenital syphilis is either of the following:

A. any infant whose mother had untreated or inadequately treated1 syphilis at the time of delivery, regardless of the findings in the infant or child
B. any infant or child who has a reactive treponemal test for syphilis and any one of the following:
  1. evidence of congenital syphilis on physical examination
  2. evidence of congenital syphilis on long bone X-ray
  3. reactive cerebrospinal fluid CSF-VDRL
  4. elevated CSF cell count or protein (without other cause)
  5. reactive test for IgM antibody.

Syphilitic Stillbirth

Defined as a fetal death in which the mother had untreated or inadequately treated syphilis at the time of delivery of a fetus after a 20-week gestation or of a fetus weighing >500g.


Signs of Congenital Syphilis

In an infant or a child younger than 2 years of age In an older child
  • condyloma lata
  • snuffles
  • syphilitic skin rash
  • hepatosplenomegaly
  • jaundice due to syphilitic hepatitis
  • pseudoparalysis
  • edema from nephrotic syndrome or malnutrition

Australian Data

The following data is based upon a table from a recent article by Jones and Jones (2010),[6] reminding physicians to be aware of maternal and congenital syphilis.

The following data is based upon a table from a recent article by Jones and Jones (2010)[7] reminding physicians to be aware of maternal and congenital syphilis.

Syphilis and Congenital Syphilis in Australia (2004 – 2007)
Year Syphilis Congenital syphilis
Male Female Total Male Female Unknown Total
2007 1231 150 1381 5 2 1 8
2006 689 182 871 6 7 - 13
2005 - - 653 8 6 1 15
2004 - - 636 11 2 - 13
Table data[7]


Bacterial Links: bacterial infection | syphilis | gonorrhea | tuberculosis | listeria | salmonella | TORCH | Environmental | Category:Bacteria


Gram Stain

Bacterial staining procedure named after Hans Christian Gram (1853 - 1938). Generally divides bacteria into either:

  • Gram-positive bacteria purple crystal violet stain is trapped by layer of peptidoglycan (forms outer layer of the cell).
  • Gram-negative bacteria outer membrane prevents stain from reaching peptidoglycan layer in the periplasm, outer membrane then permeabilized and pink safranin counterstain is trapped by peptidoglycan layer.
Links: Histology Stains | Medical Microbiology - Gram stain procedure

Historic Embryology

There is a chapter in the 1921 Contributions to Embryology publication Studies on Abortuses: A Survey of Pathologic Ova in the Carnegie Embryological Collection specifically related to syphilis.

Chapter 17. Changes Suggestive of Lues By A. W. Meyer

"Since Schaudin's discovery, attention naturally has been directed very largely from placental lesions of syphilis to the presence of spirochsetse. But unfortunately the hope that the presence of this organism would form not only a crucial but also an infallible criterion for the determination of fetal lues does not seem to have been realized. The search for spirochsetee seems to have been attended by such uncertain results that a routine examination of the placenta has not even been recommended by prominent obstetricians."
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Pages where the terms "Historic Textbook" and "Historic Embryology" appear on this site, and sections within pages where this disclaimer appears, indicate that the content and scientific understanding are specific to the time of publication. This means that while some scientific descriptions are still accurate, the terminology and interpretation of the developmental mechanisms reflect the understanding at the time of original publication and those of the preceding periods, these terms and interpretations may not reflect our current scientific understanding.     (More? Embryology History | Historic Embryology Papers)

References

  1. 1.0 1.1 Congenital Syphilis Case Investigation and Reporting Form Instructions PDF
  2. Rac MW, Bryant SN, McIntire DD, Cantey JB, Twickler DM, Wendel GD & Sheffield JS. (2014). Progression of ultrasound findings of fetal syphilis after maternal treatment. Am. J. Obstet. Gynecol. , 211, 426.e1-6. PMID: 24907700 DOI.
  3. Shahrook S, Mori R, Ochirbat T & Gomi H. (2014). Strategies of testing for syphilis during pregnancy. Cochrane Database Syst Rev , , CD010385. PMID: 25352226 DOI.
  4. Blencowe H, Cousens S, Kamb M, Berman S & Lawn JE. (2011). Lives Saved Tool supplement detection and treatment of syphilis in pregnancy to reduce syphilis related stillbirths and neonatal mortality. BMC Public Health , 11 Suppl 3, S9. PMID: 21501460 DOI.
  5. Zhu L, Qin M, Du L, Xie RH, Wong T & Wen SW. (2010). Maternal and congenital syphilis in Shanghai, China, 2002 to 2006. Int. J. Infect. Dis. , 14 Suppl 3, e45-8. PMID: 20137991 DOI.
  6. <pubmed>20618256</pubmed>
  7. 7.0 7.1 Jones IS & Jones AI. (2010). We keep forgetting maternal and congenital syphilis. Aust N Z J Obstet Gynaecol , 50, 306-7. PMID: 20618256 DOI.

Reviews

Berman SM. (2004). Maternal syphilis: pathophysiology and treatment. Bull. World Health Organ. , 82, 433-8. PMID: 15356936

Carey JC. (2003). Congenital syphilis in the 21st century. Curr Womens Health Rep , 3, 299-302. PMID: 12844452

Goldenberg RL, Hauth JC & Andrews WW. (2000). Intrauterine infection and preterm delivery. N. Engl. J. Med. , 342, 1500-7. PMID: 10816189 DOI.

Ross SM. (1982). Sexually transmitted diseases in pregnancy. Clin Obstet Gynaecol , 9, 565-92. PMID: 6293753

Articles

Colombo DF, Lew JL, Pedersen CA, Johnson JR & Fan-Havard P. (2006). Optimal timing of ampicillin administration to pregnant women for establishing bactericidal levels in the prophylaxis of Group B Streptococcus. Am. J. Obstet. Gynecol. , 194, 466-70. PMID: 16458647 DOI.

Nowicki S, Selvarangan R & Anderson G. (1999). Experimental transmission of Neisseria gonorrhoeae from pregnant rat to fetus. Infect. Immun. , 67, 4974-6. PMID: 10456962

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Cite this page: Hill, M.A. (2019, January 23) Embryology Abnormal Development - Syphilis. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Abnormal_Development_-_Syphilis

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