Congenital syphilis still a grave concern

A 2013 study by international researchers published in PLOS Medicine shows that syphilis still affects large numbers of pregnant women worldwide, causing serious health problems and even death to their babies, yet this infection could be prevented by early testing and treatment. Congenital syphilis is a severe, disabling infection often with grave consequences seen in infants. It occurs due to the transmission of the disease from an infected mother to the unborn infant through the placenta. Latent infections could be inherent in an expectant mother during the nine-month spell of pregnancy. Without taking any chances, checkups for diseases are emphasised plus regular antenatal visits. The World Health Organisation recommends that the term “mother-to-child-transmission of syphilis” should be used in place of congenital syphilis in order to increase awareness of the full spectrum of adverse outcomes, including stillbirths, neonatal deaths, premature and low birth weight infants, as well as deformities at birth. The World Health Organisation says syphilis continues to be an important cause of adverse outcomes of pregnancy, including substantial numbers of perinatal deaths and disabilities. Estimates by the World Health Organisation show that in 2008, 1.4 million pregnant women around the world were infected with syphilis, 80 per cent of whom had attended antenatal care. The researchers reached this figure by using information on the number of syphilis infections from 97 countries and on antenatal clinic attendance from 147 countries and then computed this information into a model. In consultation with experts, the authors used a realistic scenario to estimate the percentage of pregnant women tested for syphilis and adequately treated, ranging from 30 per cent for Africa and the Mediterranean region to 70 per cent for Europe. Based on this scenario, the authors estimate that in 2008, syphilis infections in pregnant women caused approximately 520,000 harmful outcomes, including 215,000 stillbirths, 90,000 neonatal (baby) deaths, 65,000 preterm or low birth-weight babies, and 150,000 babies with congenital infections. Concern for mothers The 2012 Rwanda Annual Health Statistics indicate that 159 infants faced mortality because of congenital malformations, while 192 infants faced neonatal morbidity. Thamar Nyiransabiyaremye, a supervisor in charge of immunisation and antenatal healthcare at Kibogora Hospital, says among the vital things checked for during the antenatal visits are infections, including syphilis. “We encourage mothers to receive treatment for all such infections at an early stage to prevent transmission to the baby,” Nyiransabiyaremye says Although maternal syphilis rarely causes direct harm to the pregnant mother, it is the root cause of congenital syphilis. “Do not leave syphilis untreated during pregnancy because it can cause foetal loss, stillbirth and unfortunately in a live born infantâ€•neonatal death, prematurity, low birth weight are most likely,” Nyiransabiyaremye warns. Signs and symptoms Dr Jeanne Nyiransabimana, a gynaecologist, Kibagabaga Hospital, says the signs and symptoms of congenital syphilis are arbitrarily divided into early manifestations, which appear in the first two years of life and thereafter followed by late manifestations. Early congenital syphilis usually starts in between birth and about three months of life, with most cases occurring within the first five weeks of life. Because of their frequency and early appearance the changes in the bones, especially the femur and humerus, are of diagnostic value. Other symptoms include rhinitis, inflammation of the respiratory passages and snuffles, which are persistent and often bloody in in the first week of life. A syphilitic rash, typically consisting of small spots that are dark red to copper, usually appears after one to two weeks of rhinitis and is most severe on the hands and feet. As the rash fades, the lesions become coppery or dusky red. Fissures often develop about the lips and anus. They bleed and heal with scarring. White mucous patches may be found on any of the mucous membranes. On the outer skin, changes include exfoliation of the nails, loss of hair and eyebrows, inflammation of the iris. Late manifestations of congenital syphilis are the result of scarring from the early systemic disease and include involvement of the teeth, bones, eyes, and gummas (soft non cancerous growth) in the viscera, skin, or mucous membranes. Characteristic changes of the teeth include a jagged appearance on the biting edges of the upper central incisors. Inflammation of the cornea is the most common late lesion. Bony changes include sclerosing lesions, saber shin, frontal bossing and gummatous or destructive lesions within long bones. The World Health Organisation calls on women who fail to be screened during pregnancy to at least be screened after delivery especially in high prevalence populations.