Abnormal Development - Syphilis

Embryology - 1 Dec 2023        Expand to Translate
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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)."

Some Recent Findings

Congenital Syphilis: A Discussion of Epidemiology, Diagnosis, Management, and Nurses' Role in Early Identification and Treatment "Syphilis is caused by the spirochete bacterium Treponema pallidum. Syphilis left untreated, or inadequately treated during pregnancy, can result in congenital syphilis (CS). Congenital syphilis can lead to severe sequelae or fetal, neonatal, or infant death. PURPOSE: To discuss the epidemiological trends, pathophysiology, diagnosis, and management of CS; the implications of CS upon the infant; as well as the importance of the nurse's role in the prompt identification of CS and the timely interventions needed to minimize sequelae. METHODS: A literature search was completed using ProQuest, CINAHL, Google Scholar, and PubMed. Articles published within the past 10 years were included. FINDINGS: Epidemiological trends of CS in the United States indicate that maternal syphilis infection and CS are on the rise. Risk factors include ethnicity, socioeconomic status, access to prenatal care, and sexual behaviors, as well as compliance with prenatal syphilis screening by prenatal providers. Risks of CS to the developing fetus begin at approximately 14 weeks. Timely treatment is necessary to minimize or eliminate mortality and morbidity. IMPLICATIONS FOR PRACTICE: Evidence-based, interprofessional strategies, which promote a collaborative perinatal/neonatal preventative approach to care of the pregnant female, are indicated to reverse the increasing incidence of CS within the United States. Strategies prioritizing early identification and treatment of at-risk neonates are necessary to reduce/eliminate the devastating long-term consequences of CS upon this vulnerable population. IMPLICATIONS FOR RESEARCH: The paucity of research, which focuses on CS, is most likely due to ethical concerns related to infants as research participants and provides an opportunity for future research. Future research could focus on factors that focus on maternal-fetal/maternal-child transmission of CS." Fetal and Placental Pathology in Congenital Syphilis: A Comprehensive Study in Perinatal Autopsy "At autopsy, without available serologic information, diagnosing congenital syphilis (CS) relies on identification of Treponema pallidum in tissues. Recognition of clues leading to detection of the organism is important. MATERIALS AND METHODS: Autopsy cases with CS were studied for fetal and placental abnormalities. RESULTS: Twenty-one cases were recruited: 12/21 with identifiable T. pallidum and 9/21 with positive serology and characteristics of CS. 20/21 (95%) demonstrated ≥1 fetal abnormalities. Chronic stress involution of thymus was most common. Hydrops and hepatosplenomegaly were found in >50%. Metaphyseal abnormalities and organ inflammation were found in <30%. Mucocutaneous lesions were lacking. Placental abnormalities were identified in 20/21 (95%). Placentomegaly was most common. Amniotic fluid infection (AFI) was noted in >50%. CONCLUSION: Common findings in CS at autopsy include chronic stress involution of thymus, hydrops, and hepatosplenomegaly. Mucocutaneous lesions are uncommon. Common placental findings in fetal deaths due to CS include placentomegaly and AFI." Progression of ultrasound findings of fetal syphilis after maternal treatment "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."

More recent papers

This table allows an automated computer search of the external PubMed database using the listed "Search term" text link. This search now requires a manual link as the original PubMed extension has been disabled. The displayed list of references do not reflect any editorial selection of material based on content or relevance. References also appear on this list based upon the date of the actual page viewing. References listed on the rest of the content page and the associated discussion page (listed under the publication year sub-headings) do include some editorial selection based upon both relevance and availability. More? References | Discussion Page | Journal Searches | 2019 References | 2020 References Search term: Abnormal Development Syphilis | Congenital Syphilis

Older papers

These papers originally appeared in the Some Recent Findings table, but as that list grew in length have now been shuffled down to this collapsible table. See also the Discussion Page for other references listed by year and References on this current page. Review - Strategies of testing for syphilis during pregnancy "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 "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. "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)

Treponema Pallidum

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.

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	interstitial keratitis nerve deafness anterior bowing of shins frontal bossing mulberry molars Hutchinson’s teeth saddle nose rhagades Clutton’s joints

Australian Data

The following data is based upon a table from a recent article by Jones and Jones (2010), 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) 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 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."

Historic Disclaimer - information about historic embryology pages

Pages where the terms "Historic" (textbooks, papers, people, recommendations) 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, interpretations and recommendations may not reflect our current scientific understanding.     (More? Embryology History | Historic Embryology Papers)

References

Reviews

Rac MW, Revell PA & Eppes CS. (2017). Syphilis during pregnancy: a preventable threat to maternal-fetal health. Am. J. Obstet. Gynecol. , 216, 352-363. PMID: 27956203 DOI.

Shahrook S, Mori R, Ochirbat T & Gomi H. (2014). Strategies of testing for syphilis during pregnancy. Cochrane Database Syst Rev , , CD010385. PMID: 25352226 DOI.

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

Nelson R. (2018). Congenital syphilis and other STIs rise in the USA. Lancet Infect Dis , 18, 1186-1187. PMID: 30507406 DOI.

Patel NU, Oussedik E, Landis ET & Strowd LC. (2018). Early Congenital Syphilis: Recognising Symptoms of an Increasingly Prevalent Disease. J Cutan Med Surg , 22, 97-99. PMID: 28821219 DOI.

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

Search Pubmed

Search NCBI Bookshelf: Medical Microbiology - Syphilis Search

Search PubMed: Congenital Syphilis | Abnormal Embryology Syphilis | Abnormal Development Syphilis

External Links

External Links Notice - The dynamic nature of the internet may mean that some of these listed links may no longer function. If the link no longer works search the web with the link text or name. Links to any external commercial sites are provided for information purposes only and should never be considered an endorsement. UNSW Embryology is provided as an educational resource with no clinical information or commercial affiliation.

• CDC (USA)
  • CDC Fact Sheet - STD and Pregnancy
  • CDC Fact Sheet - Syphilis
  • Congenital Syphilis Case Investigation and Reporting Form Instructions PDF
  • Public Health Training Network Epidemiology and Prevention of Vaccine-Preventable Diseases (viewable Webcasts requires Media Player) | Advisory Committee on Immunization Practices (ACIP) Recommendations
• Medline Plus
• Office on Women's Health (USA) Fact Sheet - Syphilis
• Royal College of Obstetricians and Gynaecologists (UK) Infection and Pregnancy - study group recommendations (Jun 2001)

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Cite this page: Hill, M.A. (2023, December 1) Embryology Abnormal Development - Syphilis. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Abnormal_Development_-_Syphilis

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© Dr Mark Hill 2023, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G