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Flora Shore

on 4 January 2014

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Transcript of Syphilis

Implications for Midwifery Services
Average age for a woman to be diagnosed with syphilis: 28 years, the same as the average age for a woman to have her first baby

Congenital syphilis rates are rising...
Around 10 cases per year are reported to GUM clinics, this may only be 30-50% of the true number
Syphilis Rates
1495: First confirmed syphilis outbreak in Europe
1853-1945: During the Crimean War, WWI and WWII rates increased and syphilis was recognised as a major public health issue across the UK and Europe

1916-1917: Clinics established across UK to provide free testing and treatment
1943: Penicillin became available. Rates generally declined through the second half of the 20th Century
Rates are on the rise...
Syphilis diagnosis rates in the UK were at their lowest in the mid-1990s
Rates increased from 1997 following outbreaks in Bristol, Manchester, Brighton and London, and have been rising ever since
In 2007 there were 3789 new diagnoses - the highest number since 1950
Why screen for syphilis?
* Important health problem
* Recognised latent phase
* Accurate test that is cheap and widely available
* Effective treatment available
* Early treatment in pregnancy benefits mum and baby
What is the test?
Treponomal antibody
(syphilis serology)
Screening in pregnancy
+ Positive result +
- Negative result -
Does not mean they don't have it!

Antibodies may not be detectable for up to 3 months
* Untreated infection
* Past treated infection
* Yaws
Breastfeeding does not result in infection unless there is a lesion on the breast



Contributing factors:

Needle stick injury

Needle Sharing




Main transmission is through
contact of a sore (chancre)
via sexual contact.

Via a
Blood Transfusion


Types/Stages of Syphilis
Incubation Period
Primary Stage
Secondary Stage
Tertiary Stage
Congenital Syphilis
Incubation Period
This stage is before any signs or symptoms appear, lasts around 9-90 days with the average being 21 days.
Primary Stage
This stage lasts around 1-5 weeks and is when the infection is highly contagious. Normally identified by the formation of a single chancre/sore.
Secondary Stage
This stage lasts around 4-6 weeks and 25% of all syphilis cases will reach this stage. It is highly contagious now and some symptoms can be hair loss, sore throat and headaches.
Tertiary Stage
The infection is usually no longer infectious at this point and can involve the brain and the heart. It can cause extensive damage to the internal organs and brain and possibly lead to death.
Congenital Syphilis
May occur during pregnancy or birth and can cause miscarriages, pre term birth and still births. Can lead to deformities and severe abnormalties in the child.
Transmitted through placenta or contact with sore during birth
Syphilis and Pregnancy
50% of those with untreated early syphilis will end up with an infected baby

1-2% who seek treatment will end up with an infected baby

* damage to bones, skin, organs and heart abnormalities
* pre-term labour
* Neurological problems
*Non-immune hydrops fetalis
* Miscarriage
* Perinatal Death
Overly large placenta
Fluid in the fetal abdomen

Severe swelling of or enlarged liver or spleen
What you might see on an ultrasound scan
Abnormalities at Birth
* skin rash
* legions - on mouth, genitals or anus
* abnormal nasal secretions
* anaemia
* pneumonia
* swollen lymph glands
* congenital syphilis
* Vision & hearing loss

* Neurological problems

* Bone and teeth deformities
Problems later in life

Treatment can stop the infection but cannot repair any damage that has already been caused by tertiary syphilis

for Syphilis

Allergic to Penicillin?

Will Syphilis go away without treatment?
but testing and treatment is
available free on the NHS

Risks in pregnancy?

Syphilis can be successfully treated in pregnancy

There are no risks to your unborn baby
from the antibiotics

Treatment in Pregnancy

First and Second Trimester
– Single dose of Benzathine Penicillin

Third Trimester
– first dose of Benzathine Penicillin followed by a second dose one week later

Late latent syphilis
– Treat as for non pregnant ladies, but avoid tetracyclines

The Cure?

Primary and Secondary
Syphilis can successfully treated with a
single dose of 2.4 Mega Units of Benzathine Penicillin

syphilis needs a longer course of antibiotics

syphilis (WHO guidelines, 2003)
For symptomatic newborns, the recommended treatment is
Aqueous crystalline Penicillin G 100,000 – 150,000units/kg daily IV for 10 days
Benzathine Penicillin 50, 000 units/kg daily IM for 10 days

Alternatives are available…
Ceftriaxone, Erythromycin
or Azithromycin

Can also be transmitted....
Age distribution of syphilis diagnoses by sex and sexual orientation, 1999-2008
(HPA 2009)

TRE’ ‘PON’ ‘E’ ‘MA’
‘PAL’ ‘LI’ ‘DU’ ‘IM’

Syphilis and its Symptoms

There are 3 Stages of Sypilis




Primary lesion
A sore will appear where the bacteria was first contracted
Swelling of the lymp glands
Reassurance – Positive that we have isolated the infection as she will receive the care she needs and hopefully a better outcomes for Mum and baby.
Be positive. Early treatment can reduce the risk of passing Syphilis to the baby from 50% to 1-2%
Clear, swift action. Referral to GUM clinic.
If giving leaflet. Underline important information, highlight positive stats, so she can continue to be reassured at home.
Careful documentation.
Midwife’s initial response

Not all positive screening test results will be confirmed as a syphilis diagnosis or as an infection requiring treatment.
Treatment needs to be instituted as early as possible to avoid adverse outcomes of pregnancy.
Non attendance for assessment should be reviewed as soon as possible and a plan agreed.

Urgency to complete the assessment is because:

Need for further serology testing to provide a diagnostic result.
The significance of the syphilis infection to maternal health, the pregnancy and the baby’s health.
Referral to GUM clinic and the benefits of MDT approach to care.
Practical arrangements e.g date options for appointments.

Initial discussion with the woman.

ANC Midwife will contact the woman to arrange an appointment to come in and discuss results and discuss referral to GUM clinic.
Midwife should contact health advisor at GUM clinic to advise of the referral and to facilitate fast tracking if the woman attends and follow up if she doesn’t.
What happens if you test positive for syphilis in pregnancy?

There are 3 Stages of Sypilis


’ ‘LI’ ‘
’ ‘IM’

‘TRE’ ‘
’ ‘E’ ‘

Syphilis is a bacterial infection

Syphilis & its Symptoms
Treponema paliduim
www.infectious diseases.screening.nhs.uk
National Institute for Health and Care Excellence (2008) Antenatal care: routine care for the healthy pregnant woman [CG62]. London. NICE
Transmitted through sexual contact or from Mum to baby.
Incubation period. 9 - 90 days asymptomatic
Primary phase 1 - 5 weeks highly contagious
Secondary phase 4 - 6 weeks highly contagious
Tertiary phase. No longer infectious. Can cause extensive damage to internal organs
Treatment. One dose of Penicillin during primary and secondary phases. Tertiary Syphilis will require a longer course of Antibiotics.
Treatment can reduce the risk of baby having congenital syphilis to 1-2%
MDT care recommended in pregnancy
Breastfeeding not contraindicated unless there is a lesion on the breast.
ONS (2013)
Statistical bulletin: Live Births in England and Wales by Characteristics of Mother 1, 2012
. Retrieved from http://www.ons.gov.uk/ons/rel/vsob1/characteristics-of-Mother-1--england-and-wales/2012/sb-characteristics-of-mother-1--2012.html on 5/11/2013.
Choi CQ and Livescience (2011)
Case Closed? Columbus introduced syphilis to Europe
. Retrieved from http://www.scientificamerican.com/article.cfm?id=case-closed-columbus&page=2 on 5/11/2013.
Green T, Talbot MD & Morton RS (2001) The control of syphilis, a contemporary problem: a historical perspective.
Sexually Transmitted Infections
Hall LA (2001) Venereal disease and society in Britain, from the Contagious Diseases Acts to the National Health Service. In
Sex, Sin and Suffering: Venereal Disease and European Society Since 1870
(Davidson R & Hall LA eds.) pp 120-136.
HPA (2009)
Syphilis and Lymphogranuloma Vereneum: Resurgent sexually transmitted infections in the UK
. Health Protection Agency, London.
Hall (2001)
Green et al (2001)
Image from http://ilovebacteria.com/treponema.htm
HPA (2009)
ONS (2013)
Respiratory system
Central nervous system
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