> Syphilis in newborns

The clinical manifestations of syphilis are diverse, which proves the multiple nature of the damage to the organs and systems of the fetus or newborn. Depending on the age of the baby, the symptoms of the disease will differ both externally and in the activity of the pathological processes in the body.

This type of syphilis is characterized by a vivid typical picture and the presence of clear symptoms that make it possible to diagnose the disease even before the birth of a child.

The death of a fetus infected with syphilis occurs more often at 6-7 months of pregnancy in women who have had syphilis (often less than three years) and those who have never received treatment for the disease. Spirochetes actively multiply in the tissues of the lymphatic and blood vessels, as a result of which inflammation develops in them, and their lumen also noticeably narrows. As a result of these processes, the blood and lymph flow in the placenta is significantly disturbed, and the nutrition of the fetus worsens. Such violations are the main cause of intrauterine death of the unborn child.

The characteristic symptoms of congenital syphilis of the fetus are most clearly monitored from 4-5 months of pregnancy. The symptoms of the disease are as follows:

An increase in the mass of the placenta. The normal ratio of the weight of the placenta to the weight of the fetus is 1:5, 1:6. With syphilis, this correspondence is within 1:3 or 1:4
hypertrophy of the placenta, which is accompanied by the growth of the connective tissue of the villi, the walls of blood vessels. In the future, this leads to narrowing of the lumen of blood vessels and disruption of nutrition and oxygen supply to the fetus.
proliferation of the walls of blood vessels throughout the body. The capillaries are the first to suffer.
delayed growth and development of internal organs
fetal liver damage. Accompanied by its increase, compaction, smooth surface, as well as the growth of connective tissue in it
enlargement and hardening of the spleen
underdevelopment of certain parts of the brain
diffuse, inflammatory processes in the membranes of the brain and spinal cord of the fetus
proliferation of connective tissue and narrowing of the lumen of blood vessels in the brain
profuse desquamation and exfoliation of epithelial cells that lines the alveoli of the fetal lungs
proliferation of tissue cells that fill the space between the alveoli
underdevelopment of the glomeruli and tubules of the kidneys
cysts in the kidneys
delayed development and formation of the kidneys
adrenal lesion
pituitary lesion
proliferation of connective tissue in the gonads, as well as the formation of foci of necrosis (dead areas) in them
violation of the process of hormone production in the body of the fetus, which leads to a delay in somatic and mental development
development of the initial stages of bone damage - osteochondritis, which actively manifests itself closer to 6 months of a baby's life

Multiple intrauterine lesions of the fetal body lead to a decrease in its viability, which causes early death. If the characteristic violations are expressed very weakly, then the child is born alive. But his body is extremely weakened and affected by serious pathological processes.

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Hutchinson's triad is a characteristic manifestation of congenital syphilis

Manifestations of congenital syphilis in infancy:

In many ways, the manifestations of syphilis in infants are similar to the picture of the disease in the fetus. All children born with a congenital form of the disease are characterized by extremely weak immunity. As a result, such babies are unstable to various infectious diseases.

The symptomatology of syphilis in infants is most actively manifested in the first two months. Very rarely, signs of the disease are clearly visible immediately after birth.

The defeat of the body in this age period is often of a general, generalized nature. Pathological processes affect the entire body of the newborn. Before the onset of symptoms characteristic of syphilis in babies up to 2-4 months old, the following previous signs are noted:

Severe pallor of the skin
brownish or earthy skin
very strong anxiety of the baby at any time of the day, regardless of the meal. Develops due to increased intracranial pressure
convulsions
lag in physical development
slow weight gain. It is noted with normal appetite, as well as the absence of disorders of the stomach and intestines
lethargy
loss of appetite
dystrophy

In milder forms of the disease, one or two organs are affected. As a result, the clinical picture of syphilis will be less pronounced, and the baby's condition will be noticeably better.

At the age of 4 months to 1 year, children have an activation of immunity, which helps to increase the child's resistance to infections and other diseases. Therefore, congenital syphilis at this age is diagnosed extremely rarely.

Skin manifestations of congenital syphilis:

In addition to the various lesions characteristic of congenital syphilis of the fetus, for newborns up to 4 months are typical skin manifestations of the disease :

Eruptions. They can be represented either by individual elements, or by continuous infiltration of the child's skin (most common in infancy)
the appearance of a syphilitic rash closer to 8-10 weeks of a baby's life
the appearance of spots that quickly merge with each other. This phenomenon often precedes the appearance of a rash.

Features of the defeat of the face and scalp:

The presence of a characteristic rash on the face, especially in the lips and chin
thickening of the baby's lips, their swelling and increased shine
the formation of bleeding tears of the skin of the lips, especially when screaming, crying and eating
the formation of persistent scars at the site of cracks in the lips - a characteristic sign of syphilis in infancy
formation of crusts on the chin
increased and intense formation of typical crusts on the cheeks and forehead
seborrheic process with the formation of abundant crusts at the border of the forehead and scalp
the formation of crusts on the eyebrows is an important diagnostic sign of syphilis
loss of eyebrows, eyelashes, hair as the disease progresses

Features of damage to other areas of the skin:

Extensive reddening of the skin on the feet and soles, followed by thickening of the affected areas
lesions with a characteristic rash and infiltration of the skin in the back of the thigh, legs, buttocks, scrotum in boys and vagina in girls. The rash can be with the formation of weeping, ulcers, bleeding areas that are devoid of the epidermis
the formation of a rash, cracks, ulcers in the area of ​​\u200b\u200bthe folds at the anus. Such pathological processes end with the formation of scars.

The earliest form of rash in syphilis is syphilitic pemphigus. It can often be expressed at birth and is localized in such areas of the body:

soles
palms
shins
forearms
torso
face

The size of such a rash - from a pea to a cherry. At first it is filled with liquid contents, which later turns into pus with blood impurities. The bubble is always surrounded by an inflammatory edging. The rash may merge, burst, bleed, crust, and flake.

Often, infants are diagnosed syphilitic papular rash. It is characterized by the following features:

Lasts for the first 6 months of a child's life
appears within the first week after birth
papules are dense
color papules pink, red with a specific sheen
over time, the papule begins to peel off, sometimes it takes on a weeping form
primary localization sites of papules: limbs, buttocks, face, corners of the mouth, anus
papules, especially wet ones, are painful, which makes it difficult for the child to suckle, defecate, etc. normally.

Damage to internal organs in congenital syphilis:

The defeat of internal organs in syphilis in infants is characterized by such disorders:

Enlargement and thickening of the liver
enlargement of the spleen
cracked and brittle nails
damage to the nail bed, which leads to exfoliation of the nail plate
baldness
damage to the nasal mucosa, which leads to the formation of a stable syphilitic rhinitis. The nasopharynx is not affected in this process. Often, a runny nose for a long time remains the only symptom of syphilis in a child.
perforation and softening of the nasal septum, which leads to its deformation
hoarseness due to damage to the larynx
soundlessness of voice
meningitis - inflammation of the lining of the brain
syphilitic hydrocephalus. As a result of this disease, the skull of a newborn takes on a special specific shape: small size, elongated shape, protrusion of the fontanel with dense edges upwards. In such children, the head of the skull predominates over the front
irritation of the soft membranes of the brain, resulting in convulsions, paralysis, increased intracranial pressure, increased anxiety of the baby
eye damage by the type of chorioretinitis against the background of normal vision, damage to the optic nerve
pupillary constriction, serrated pupil
damage to the bone apparatus, which is manifested by osteochondritis. Predominant damage occurs to the hips, forearms
Parrot's disease, which is characterized by a violation of the motor function of the limbs, swelling, soreness against the background of preservation of sensitivity
osteoporosis
syphilitic phalangitis, in which the bones of the fingers and heels are affected
a typical phenomenon in syphilis is a combination in one bone of the processes of destruction and restoration
changes in the lungs, which often lead to the death of the child almost immediately after birth
damage to the adrenal glands and kidneys, which is manifested by the phenomena of nephritis, nephrosis
testicular lesion
enlargement and hardening of the lymph nodes, especially inguinal, cervical and elbow

How to prevent syphilis and reduce its manifestations?:

It is important to remember that a number of important measures will help prevent or mitigate life-threatening consequences and disorders for a small organism:

Diagnosis of syphilis in parents before conception
timely and correct treatment of syphilis in parents, especially mothers
continuation of treatment of a woman after the onset of pregnancy, if necessary. It is important to understand that the danger of syphilis to the fetus is much greater than the negative impact of drugs to treat the disease.
careful monitoring of the condition and development of the fetus, which is carried by an infected woman, throughout pregnancy
early diagnosis and effective treatment of a child diagnosed with congenital syphilis
organization of correct diagnosis and medical care for a fetus diagnosed with congenital syphilis

Syphilis (lues) is a sexually transmitted disease, usually chronic, of an infectious nature, characterized by systemicity. It is manifested by specific lesions of the skin, all mucous membranes, most bones, various internal organs, and most importantly, the nervous system. It is caused by a dangerous, very active bacterium, which received a sonorous name - pale treponema. Transmitted (most often) sexually, as well as through household items.

Congenital syphilis is especially dangerous in children, when a dangerous infection is transmitted to a child from a sick mother through the placenta. It can be diagnosed at different ages, and therefore there are several types of the disease.

Types of congenital syphilis

The classification of congenital syphilis detected in children is based on the age at which this disease manifests itself. The range is quite wide: from infancy to adolescence.

For further prognosis, the time of manifestation of specific lesions is of great importance: the earlier the symptoms are detected, the more favorable it is. Doctors diagnose the following forms of the disease.

early congenital syphilis

• Fetal syphilis

Most often, doctors diagnose early congenital syphilis of the fetus when intrauterine infection occurs. If this happened at 5-6 months, premature birth may begin. The baby is usually born dead, macerated (flabby, swollen, loose body), with pathologies of the lungs, spleen, liver.

• syphilis of infancy

If the infection of the mother occurred in late pregnancy, the symptoms of the disease appear after the birth of the baby. When diagnosing syphilis in infancy, the Wasserman reaction is detected only at the 3rd month of a newborn's life.

• Syphilis in early childhood

This form of the disease is said if it manifested itself between the ages of 1 and 4 years.

late congenital syphilis

In most cases, late congenital syphilis manifests itself and is diagnosed in children in adolescence, without revealing itself before. This is a dangerous recurrence of a disease suffered in early childhood - not detected or insufficiently treated in time.

Latent congenital syphilis

This form of the disease can be observed in a child at any age. Its complexity is that it usually proceeds in the absence of symptoms. Therefore, latent congenital syphilis can only be detected as a result of serological studies (carried out on the basis of biological material, most often cerebrospinal fluid).

All these forms of congenital syphilis do not pass without a trace. Among the most dangerous consequences are disability and mortality. The symptomatology of a latent disease allows the child to live up to a certain point, and he will not differ in any way from his peers in his development. However, you need to understand that someday the infection will still manifest itself.

through the pages of history. Syphilis was named in 1530 by an Italian poet and doctor named Girolamo Fracastoro.

Causes of the disease

Pale treponema infects the fetus, penetrating to it into the placenta through the lymphatic slits of the vessels or the umbilical vein. It is transmitted to a child from a mother with syphilis. Children are at risk if:

• the infection of the woman occurred before conception;
• infection was diagnosed at different stages of pregnancy;
• the mother is ill with secondary or congenital syphilis.

The transmission of bacteria from mother to child occurs in the first years of her infection, when the stage of the disease is active. With the passage of age, this ability gradually weakens.

If a woman suffers from a chronic form, but is constantly being treated, she may well have a healthy baby. Therefore, it is necessary to constantly undergo special examinations and carefully monitor the condition of the fetus during its intrauterine development, and then - for its health in the future, in order to detect even a latent form of the disease in time. To do this, you need to know the clinical picture of the course of the infection, i.e., its symptoms.

Keep in mind! The transmission of the infection to the fetus from the sperm has not been scientifically proven, so there is no point in blaming the father of the child for congenital syphilis.

Symptoms

Since there are still chances for a healthy baby to appear if the mother is infected, it is necessary to identify signs of congenital syphilis in time even at the stage of intrauterine development of the fetus. This will allow you to take the necessary measures, find out the degree of infection activity and make at least some forecasts for the future. The symptomatology of the disease is very diverse and largely depends on the stage at which it was detected, that is, on its form.

Symptoms of congenital syphilis of the fetus

• Large size of the fetus;
• small body weight;
• maceration (swelling, friability);
• enlarged liver, its atrophy;
• enlarged, compacted spleen;
• underdeveloped kidneys, covered with a crust;
• stomach ulcers;
• damage to the central nervous system, brain.

Symptoms of congenital syphilis of infancy

• Dry, wrinkled face;
• a large head with strongly developed tubercles on the forehead, a pronounced venous network, seborrheic crusts;
• pigmentation on the face;
• sunken nose bridge;
• pale, dirty yellow, flabby skin;
• thin, cyanotic limbs;
• the child is restless, constantly crying, sleeping poorly, screaming piercingly;
• poor development;
• weight loss;
• persistent runny nose, which causes difficulty in breathing and sucking;
• dystrophy with a complete absence of fatty subcutaneous tissue;
• over time, bedsores form;
• syphilitic pemphigus on the palms, soles, face, elbows, knees: large vesicles with purulent contents;
• epidemic pemphigus - these are large blisters merging with each other, bleeding, eroded, accompanied by high fever, diarrhea, green stools;
• diffuse thickening of the skin - scaly erosion on the palms, face, soles, head, accompanied by hair loss and eyebrows, swelling of the lips, cracks in the corners of the mouth, crusts on the chin, ulcers on the entire surface of the body;
• erysipelas;
• redness of the heels;
• papular syphilide - the formation of copper-red papules and age spots;
• roseola rash - individual scaly brownish spots that tend to merge;
• syphilitic alopecia - loss of hair, eyelashes, eyebrows;
• syphilitic rhinitis - hypertrophy of the mucous membrane of the nose, mouth, larynx;
• Wegner's syphilitic osteochondritis is a pathological lesion of the skeletal system, which often leads to a false paralysis-like condition, when the upper limbs hang with whips, the lower ones are constantly bent at the knees;
• damage to the joints in congenital syphilis in an infant is expressed by a movement disorder, complete immobility of the limbs;
• eye damage is sometimes the only sign of congenital syphilis: the fundus is pigmented, later - loss of vision, keratitis.

Symptoms of congenital syphilis at an early age

• The skin of the genitals, groin, anus, interdigital folds on the legs are affected by limited large weeping papules;
• roseolous rashes;
• seizures in the corners of the mouth;
• papules on the mucous membrane of the larynx merge, causing a hoarse, hoarse voice, aphonia, stenosis of the larynx;
• syphilitic rhinitis;
• baldness;
• swollen lymph nodes;
• periostitis, osteoperiostitis, osteosclerosis - a pathological lesion of the skeletal system;
• enlargement, hardening of the spleen and liver;
• nephrosonephritis (kidney dystrophy);
• enlargement, hardening of the testicles;
• as a result of damage to the nervous system, mental retardation is often diagnosed with congenital syphilis, as well as epileptiform seizures, hydrocephalus, hemiplegia (paralysis of one part of the body), meningitis;
• eye damage: chorioritinitis, optic nerve atrophy, keratitis.

Symptoms of late congenital syphilis

1. Reliable signs

• Keratitis is a pathological inflammation of the cornea of ​​the eye, which is accompanied by clouding of the mucous membrane in separate areas, photophobia, lacrimation, blepharospasm, decreased visual acuity, atrophy of the optic nerve up to complete blindness;
• dental dystrophies;
• specific labyrinthitis - deafness, combined with difficulty in speech, dumbness may occur.

1. Likely signs

• Specific drives - damage to the knee joints, which increase, swell, hurt;
• bone damage leads to the fact that the symptoms of late congenital syphilis are visible to the naked eye: the shins become saber-shaped, and the child's gait changes greatly;
• saddle nose;
• buttock-shaped skull;
• dystrophy of teeth;
• radial scars, which are called Robinson-Fournier, near the mouth, chin;
• due to severe damage to the central nervous system, oligophrenia is possible with congenital syphilis, as well as epilepsy and speech disorder;
• specific retinitis;
• dystrophy (stigma).

The external manifestation of congenital syphilis in a child rarely goes unnoticed, unless it is a latent form of the disease. The damage to internal organs and systems is so powerful and extensive that already in infancy, the symptoms are noticeable even with the naked eye. They are difficult to confuse with signs of other diseases, especially since the infection of the baby is most often talked about during pregnancy.

It is especially important for parents to know how congenital syphilis manifests itself in adolescence (i.e. late), since at the beginning of the child’s life he did not find himself outwardly, while the harmful bacterium destroyed his tissues from the inside. Under laboratory conditions, the diagnosis is refuted or confirmed fairly quickly.

Important information. If the latent form of congenital syphilis is not cured in time, the matured child will be a living carrier of pale treponema, infecting other people with it.

Diagnostics

Since the disease in the mother is detected at any stage of pregnancy, a thorough diagnosis of congenital syphilis in the child is carried out while he is still in the womb. In the future, it represents all kinds of laboratory research.

1. X-ray. The disease is detected on an X-ray examination, which is performed at 5-6 months of pregnancy. It is recognized by specific osteochondritis (inflammation of the bones) or osteoperiostitis (inflammation of the periosteum).
2. Serological reactions of Wasserman, Kolmer, Kahn, Sachs-Vitebsky (KSR). They are based on the fact that an antigen is introduced into the child's blood, and then the body's reaction to it is studied.
3. The reaction of immobilization of bacteria that cause syphilis - pale treponema (RIBT).
4. Immunofluorescence reactions (RIF).
5. Study of the cerebrospinal fluid.
6. X-ray of the osteoarticular apparatus.
7. Examination of a child by such doctors as a pediatrician, neuropathologist, ophthalmologist, otolaryngologist.

All data based on the studies carried out are entered into the protocol for diagnosing congenital syphilis, according to which the disease is being treated. This medical document accompanies the child throughout his life, the results of analyzes and reactions are regularly entered into it, which are carried out constantly to monitor the patient's condition.

With proper care and a full course of treatment, which was carried out in a timely manner, the prognosis for a sick child can be quite favorable.

through the pages of history. August Wasserman - German microbiologist and immunologist of the late XIX - early XX century, created an express method for diagnosing syphilis.

Forecasts for the future

The prognosis for the future of a child with congenital syphilis can be very different. From the risk of dying in the womb to full recovery after birth. There are many concerns during and after pregnancy:

• late miscarriage;
• premature birth;
• pathology;
• the birth of a dead baby.

It is impossible to predict what will happen in one case or another. A different outcome of pregnancy depends on numerous factors: the stages of the course of the process, the treatment that the mother has undergone or is still undergoing, the degree of intrauterine infection of the fetus, the activity of the infection, and much more.

Given the modern medical technologies that are used to treat congenital syphilis, with proper nutrition, careful care of the baby, breastfeeding, one can hope for positive results and recovery.

The timing of the start of therapy is very important. In infants with this disease, standard serological reactions are restored by the first year of life. With late congenital syphilis, they become negative less frequently.

Treatment Methods

If the disease was detected in a timely manner, the treatment of congenital syphilis in infants gives positive results. The later the diagnosis was made, as well as with a latent form of infection, the consequences for the health and life of the child can be the most unfavorable, up to death. Treatment includes drug therapy and proper care.

Medical therapy

• Vitamin therapy;
• injections of penicillin and its derivatives (ecmonovocillin, bicillin);
• phenoxypenicillin;
• bismuth (if the child is more than six months old);
• if the child is allergic to penicillin - erythromycin, tetracycline, cephalosporins;
• a combination of muscle injection of antibacterial drugs with endolumbar injection (into the spine) and with pyrotherapy (artificial temperature increase);
• arsenic derivatives (miarsenol, novarsenol);
• immunomodulators;
• biogenic stimulants.

• Regular hygiene procedures, since with such a disease, the skin of the child is primarily affected;
• breast-feeding;
• complete nutrition, which should include foods high in vitamins and proteins;
• daily regimen with meals at the same time, night sleep for at least 9 hours, as well as daytime sleep;
• daily walks or at least stay in the fresh air;
• regular spa specific treatment;
• constant monitoring and visits to the appropriate doctors.

If congenital syphilis of any form and stage is detected, the patient is placed in a venereal dispensary for therapy.

If a woman underwent appropriate treatment during pregnancy and the body of the newborn received all the necessary procedures in the first month of her life, the disease does not pose a threat to the future life of the child. If the diagnosis was made later, with latent forms and a late stage, therapy may not give results. In this case, the consequences may be the most undesirable.

Dangerous Consequences

The dangerous consequences of congenital syphilis for the further health of infected children will depend entirely on the timely course of treatment and the form of the disease. In most cases, they can still be avoided.

In the absence of specific timely therapy, the child may remain disabled for life or die due to the defeat of too many internal organs, systems and tissues by treponema.

Untreated, advanced congenital syphilis can lead to:

• mental and physical retardation;
• external deformities in the form of deformation of the skull, limbs, teeth, nose;
• dystrophy;
• dermatitis;
• baldness;
• loss of vision;
• deafness
• dumbness;
• paralysis;
• impotence in the future in boys and infertility in girls.

All these are symptoms of congenital syphilis, which, if not properly treated, progress and give rise to serious pathologies. As a result, irreversible processes lead to a child's disability for life.

Dangerous consequences, like the disease itself, can be easily avoided if preventive measures are taken in time.

Prevention

If the mother was infected before the 5th month of pregnancy, active and successful prevention of congenital syphilis is possible, since pathological metamorphoses of organs and tissues begin only at the 5th or 6th month. Therefore, treatment of the fetus in early pregnancy leads to the birth of a healthy baby. If the woman has also completed the appropriate course of therapy, the child is not in danger.

The modern level of medicine and early diagnosis of the disease make it possible to detect and treat congenital syphilis in a child in advance. This allows you to avoid dangerous consequences for the life and health of the baby in the future. An infected woman must also undergo a mandatory course of therapy and be under the close and constant supervision of doctors.

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Mulsan Cosmetic, the only company that passed all the tests, successfully received 10 points out of 10 (read). Each product is made from natural ingredients, completely safe and hypoallergenic.

If you doubt the naturalness of your cosmetics, check the expiration date, it should not exceed 10 months. Approach carefully to the choice of cosmetics, it is important for you and your child.

This diagnosis is not a sentence, it does not always end in death or disability, contrary to popular belief. Fight for your children - and even this disease will be defeated!

Syphilis often occurs in newborns. This disease is venereal. Pathology worsens the condition of the child's skin, violates the integrity of the mucous membranes, the skeletal system, and internal organs.

Pathology is caused by a harmful bacterium, which received a beautiful name - pale treponema. The disease can be contracted, first of all, in the process of intimacy.

Varieties of pathology

Syphilis has another name - lues. It can be passed from mother to baby through the placenta. Cases of lues infection are recorded in children of different ages. The sooner the baby shows the main symptoms of the disease, the more favorable the prognosis.

There are the following types of congenital lues:

• Early congenital syphilis. Often there is intrauterine infection of the unborn child. If this phenomenon is observed in the second trimester of pregnancy, a woman may begin premature birth. In some cases, the newborn cannot be saved: he is born dead. There is also syphilis in infancy. If the mother became infected with syphilis already in the last trimester of pregnancy, the first signs of pathology appear after the birth of the newborn. In some cases, signs of pathology are detected in a baby quite late: after he reaches one year old. In this case, they talk about syphilis in early childhood.
• Late congenital syphilis. With this form of the disease, the first signs of pathology are usually diagnosed in adolescence.
• Latent congenital syphilis. It occurs in children of any age. With this form of the disease, the patient does not have the characteristic symptoms of syphilis. Hidden congenital lues is often detected during a serological study. It is made on the basis of cerebrospinal fluid or some other biological material.

In some cases, latent congenital syphilis leads to disability or death of the patient. The insidiousness of this form of pathology lies in the fact that the child feels great, he is no different from his peers, develops harmoniously.

How does a newborn become infected with lues?

In order to reduce the likelihood of lues in newborns, the expectant mother needs to be registered in a antenatal clinic in a timely manner. Pregnant women donate blood twice for the Wasserman reaction. The first blood test is carried out when the expectant mother is registered. The second time the analysis must be taken at the eighth month of pregnancy.

The fetus can become infected with lues only after the placenta of a pregnant woman is fully formed, that is, at the end of the fifth month of pregnancy. If the expectant mother has a positive serological reaction, she is prescribed an appropriate course of treatment with penicillin-based medications. They help to avoid infection of the newborn with lues.

Symptoms of lues in newborns

The following signs of lues are distinguished:

• Small weight newborn.
• Enlargement of the liver and spleen.
• Flabbiness of the skin of the newborn.
• The presence of signs of damage to the brain and nervous system.
• Underdevelopment of the kidneys in a newborn.
• Yellowish skin tone.
• Irregular shape of the nose in a newborn.
• Sleep disturbance.
• The lag of the newborn in physical development.

With congenital syphilis, a child has damage to the joints and eyes. There are often pigmented areas on the fundus, which in the future can lead to loss of vision and keratitis.

In the presence of lues, a newborn often develops skin rashes. After they heal, ugly white scars often remain on the baby's body. Many newborns have a so-called syphilitic rhinitis, as a result, children sluggishly suck on their mother's breasts. Such babies gain weight rather poorly, look weak and frail.

Diagnosis of the disease

Adverse changes in the structure of the systemic organs of the fetus can be seen on ultrasound. It allows you to identify the following deviations:

• An increase in the size of the placenta.
• Accumulation of fluid in the abdominal cavity of the baby.
• Enlargement of the liver.

After the birth of the baby, such specialists as an ophthalmologist, pediatrician, dermatovenereologist examine. During the examination, the condition of the child is assessed on the Apgar scale, doctors examine the skin, mucous membranes and the condition of the fundus of the newborn. Serological examination of cerebrospinal fluid is usually done on the seventh day of a baby's life. In the diagnosis of congenital lues, a method such as radiography of the tubular bones of the legs is also used.

Caring for a newborn with lues

With syphilis, first of all, the skin of the baby is damaged, so hygiene procedures should be regular.

You must adhere to the following basic recommendations:

• The newborn needs natural feeding.
• In the presence of such a diagnosis as syphilis in newborns, the child must eat fully. In his diet must be present foods rich in vitamins and proteins.
• It is necessary to draw up a clear daily routine: nightly rest should be given at least nine hours.
• The patient needs to spend a lot of time outdoors.
• A newborn needs constant medical supervision: a medical facility must be visited regularly.

If the expectant mother has undergone an appropriate course of treatment during pregnancy, the disease does not pose a threat to the life of the baby. With a latent form of the disease, the child may experience various complications. Children with congenital lues are treated in a sanatorium.

Consequences of syphilis in newborns

With timely treatment of diseases, it is possible to avoid the occurrence of adverse effects in the newborn. Advanced forms of congenital lues can lead to serious consequences:

• Mental retardation.
• Slow physical development of the newborn.
• Dermatitis.
• Loss of hair on the head.
• External deformities (deformation of the skull, nose, teeth).
• Paralysis.
• Hearing loss.
• Loss of speech.

In the future, adult men may experience a weakening of sexual desire, female representatives with congenital syphilis are often diagnosed with infertility.

Features of the treatment of syphilis

In the complex therapy of the disease, medicines are used, which include penicillin. Treatment must begin as early as the 1st month of a baby's life.

If adverse changes in the composition of the cerebrospinal fluid or in the organs of vision are detected, the dosage of the drug containing penicillin should be doubled. Additionally, the doctor may prescribe bismuth-based medicines to the child. The interval between treatment courses is at least two weeks. The dosage of penicillin depends on the following circumstances:

In order to reduce the likelihood of side effects in a child, treatment begins with a minimum dosage of a drug containing penicillin, it is gradually increased over one to two weeks.

A prophylactic course of treatment is necessary for newborns whose mothers are infected with lues. Medicines are used even in the absence of serological and clinical signs in babies. After the completion of the prophylactic course, such patients are under the supervision of a doctor for a long time. A child who has been diagnosed with congenital syphilis is recommended to take vitamin and mineral complexes.

This disease is relatively rare in our country. The incidence of congenital syphilis in Western European countries varies between 0.01 and 2-3%. Without the presence of syphilis in the mother, there can be no syphilis in the child. Syphilis in the mother may be asymptomatic, and she may have it without obvious signs. A negative history on the part of the mother does not mean that she does not have syphilis. The fetus is always infected from the mother, regardless of whether she was sick before or got sick during pregnancy. If a mother has contracted syphilis during the last 6 to 8 weeks of pregnancy, the baby may be born healthy, but not always. Infection of the fetus occurs in utero, diaplacentally, by the hematogenous route and most often through the umbilical vein, less often by the lymphatic route. As a rule, the placenta of newborns infected with syphilis has specific syphilitic changes. With congenital syphilis, infection usually occurs by massive penetration of spirochetes into the blood of the fetus. During this period, the fetus is defenseless, it cannot produce immune bodies. Since spirochetes reproduce very quickly, there is usually no primary effect in the newborn. The penetration of spirochetes is also possible through an intact placenta. Infection of the fetus occurs not earlier than the fifth month of pregnancy. If infection of the fetus occurs in the V-VI month, premature birth is possible, sometimes the fetus is born dead and macerated. The earlier the infection of the fetus and the fresher the infection in the mother, the more severe the phenomena of congenital syphilis in the newborn. Every stillborn fetus born in the second half of pregnancy should be alert for the presence of syphilis. Infection can also occur in the last months of pregnancy or during childbirth, during separation of the placenta and in violation of its integrity. In these cases, spirochetes easily enter the child's blood and infect him. The baby is born apparently healthy. Signs of syphilis appear much later, a few weeks after birth. During this incubation period, syphilis in a newborn cannot be diagnosed, except in cases where the placenta and umbilical cord have syphilitic changes. In this incubation period, the Wasserman reaction in the child is also negative.

Currently, it is believed that syphilis can be transmitted to the offspring of the second generation (second generation), but only in cases where treatment has not been carried out. Germinal transmission, representing the primary infection of the egg with spirochetes from the father's sperm, does not exist.

Symptoms congenital syphilis varied. Changes can spread to internal organs, skin, mucous membranes, skeleton, sensory organs, central nervous system. Of the internal organs, the liver and spleen are most often affected. Enlargement of the spleen in the first weeks after birth is an almost pathognomonic sign of congenital syphilis. Its increase is the result of diffuse small cell infiltrates or small gummy foci. Moderate or significant enlargement of the spleen is observed in 70-80% of cases of congenital syphilis. The spleen is dense, with a smooth surface, often there is perisplenitis. On palpation of the spleen in these cases, crepitus is felt, resembling the creaking of snow. The liver is also enlarged, of a dense consistency due to interstitial hepatitis. At the same time, there is cell necrosis. Despite severe parenchymal changes, jaundice is rarely observed or, more precisely, the course of physiological jaundice is delayed. Severe liver damage sometimes leads to severe, with an unfavorable prognosis, dysproteinemia (Fanconi fibrinasthenia). The child's belly is swollen. Enlargement of the liver and spleen in a newborn always awakens the suspicion of syphilis, so in such cases it is necessary to immediately examine the blood for the Wasserman reaction. In the lungs, changes inherent in pneumonia can be observed. Less common are changes in the kidneys, in the form of nephrosis or hemorrhagic nephritis, accompanied by edema and pathological abnormalities in the composition of the urine (albumin, erythrocytes, cylinders). If the cardiovascular system is affected, cyanosis and difficulty in breathing may occur. If changes in the internal organs predominate, they speak of visceral syphilis, and with predominant changes in the skin, mucous membranes and bones, they speak of parietal syphilis.

Skin changes. Syphilitic pemphigus spreads mainly to the hands and feet, and in very severe cases spreads throughout the body. We are talking about vesicles ranging in size from lentil to corn or more, located on an inflamed base and filled with serous, serous-purulent or hemorrhagic fluid containing a large number of spirochetes. Such skin changes are not always observed. Their presence confirms the diagnosis of the disease, but the absence does not exclude congenital syphilis.

Maculopapular syphilitic exanthems usually appear a few weeks after birth. The rash, usually brown-red, sharply demarcated from the surrounding skin, is most often localized on the forehead, face and outer surfaces of the upper and lower extremities, on the feet, less often on other parts of the body. It resembles a measles rash. After itself, it leaves pigmentation for a long time and has a tendency to peel. In children with exudative diathesis, secondary infection and eczema often join syphilitic exanthems. Often the child's eyebrows are covered with dry, thick yellowish crusts.

Diffuse exanthems are cellular infiltrates on the skin of the face, lips, palms, soles, buttocks. They cause thickening of the skin, loss of its elasticity, so the skin becomes very brittle. The skin of the soles is inflamed, dark red or bluish in color and shines like varnish (syphilitic glossy soles). Sometimes there are large, lamellar peeling and cracks near the mouth. If the cracks go beyond the boundaries of the lips, they are especially suspicious of congenital syphilis. These cracks leave scars. Characteristic of congenital syphilis and complexion - dirty pale gray with a yellowish tint, reminiscent of the color of coffee with milk. Maculopapular exanthems and diffuse exanthems are observed in approximately 40-50% of affected children. Sometimes there are trophic changes in the nails of the fingers and toes in the form of transverse lines, which are often secondarily infected and lead to paronychia.

Mucosal changes. The earliest and most common symptom is a syphilitic coryza, causing a peculiar sniffing and difficulty breathing through the nose. Runny nose appears immediately after birth. This rhinitis is based on a diffuse inflammatory infiltrative process with hypertrophy of the nasal mucosa. In a severe inflammatory process, destruction of the septum of the hard palate may occur. At first, the child's nose is only stuffed up, but there is no secretion. Later, a mucopurulent or bloody-purulent secret appears, which gradually ulcerates the skin near the mouth, the nostrils swell, infiltrate and narrow the nasal passages. With prolonged absence of nasal breathing in a newborn, one should always think about syphilis. Syphilitic rhinitis is observed in 58-78% of cases. Sometimes diphtheria bacteria are superimposed on the altered nasal mucosa. In contrast to syphilis, with diphtheria of the nose, raids often appear on the nasal septum, and the secret resembles washing meat water and flows most often from one nostril. In such cases, diphtheria bacteria are isolated from the nasal secretion. When the mucous membrane of the larynx is affected, the child's voice becomes rattling and aphonic.

Bone changes. According to Reitz, observed in 85% of patients. The saddle nose is especially typical of congenital syphilis. However, it is not always an absolute proof of congenital syphilis, sometimes quite healthy children have this nose shape.

Osteochondritis and periostitis are bone changes characteristic of congenital syphilis. They are observed mainly in long tubular bones, and in places of increased growth (on the border between cartilage and bone), where spirochetes are layered. With osteochondritis, true inflammation is not observed, but rather calcium deposition is disturbed and osteoclast activity is reduced. The provisional ossification line expands. She is wrong, jagged. All these changes are clearly visible on the x-ray. Sometimes the metaphysis of the lower end of the humerus is separated from the epiphysis and the so-called Parrot pseudoparalysis occurs, in which the arm hangs down, passive movements are painful and the child cries. Sensitivity saved. The movements of the fingers and, to a certain extent, the forearm are also preserved. When passively raising the arm, the child cries out. In paralysis of the Erb and Klumpke types, paralysis appears immediately after birth, and syphilitic pseudo-paralysis - later. With osteochondritis, dense lymph nodes can be palpated in the area of ​​​​the shoulder joint and forearm.

Syphilitic periostitis is characterized by thickening of the periosteum. With layers of the periosteum on the bones of the skull, caput natiforme is formed, and on the fingers and in the presence of destructive changes - spina ventosa luetica, which, unlike tuberculous ones, never suppurate and do not form fistulas. Foci of osteomyelitis may also be observed.

sense organs. With congenital syphilis, the eyes are often affected with a picture of iridocyclitis and chorioretinitis. Changes in the fundus of the eye are also characteristic. It looks like it's been sprinkled with salt and pepper. Chorioretinitis usually resolves without leaving blindness.

central nervous system. An early symptom of congenital syphilis is the unreasonable screaming of a child, sometimes convulsions. In 25-50% of patients, lumbar puncture proves the presence of serous meningitis with positive globulin reactions, mild pleocytosis with an increase in the number of monocytic cells. The reactions of Wasserman and Kahn are sharply positive. Hydrocephalus in congenital syphilis is rare. It is usually communicating and is formed, as a rule, not earlier than three months later, and only in those cases when the meningeal process continues, large areas of the subarachnoid spaces are blocked, as a result of which the resorption of cerebrospinal fluid becomes more difficult. In rare cases, gummas are formed in the brain, manifested by a picture of mono- and hemiplegia, convulsions such as Jacksonian epilepsy and mental disorders.

Congenital syphilis is also accompanied by general symptoms: anxiety, lethargy, suspension of weight gain, sweating, nightly screams. Unexplained fevers and indigestion are often observed. Children are pale and in some cases prone to bleeding. In the peripheral blood, moderate hypochromic anemia and leukocytosis are noted. The erythrocyte sedimentation rate is often accelerated.

Diagnosis in the neonatal period is not particularly difficult in the presence of the described signs. It is somewhat more difficult to make a diagnosis with the visceral type, and it is especially difficult when congenital syphilis is asymptomatic. In such children, only pale skin and a slightly enlarged spleen may suggest the presence of this disease. Skin and other changes appear later. Wasserman's reaction is negative. When making a diagnosis, one should always keep in mind the diversity of clinical symptoms. At the slightest suspicion of the presence of congenital syphilis, it is necessary to carry out Wasserman and Kahn serological tests, X-rays of bones and an examination of the fundus. A positive Wasserman reaction in a child with clinical manifestations of syphilis usually confirms the diagnosis, since a nonspecific positive Wasserman reaction without the presence of syphilis is an exception. In this case, the reaction must be repeated. However, a negative Wasserman reaction does not always rule out syphilis, since a certain period is necessary for the formation of antibodies, most often several weeks. If the Wasserman reaction remains negative until three months after birth, the likelihood of congenital syphilis is very small. In the presence of clinical signs, the Wasserman reaction is usually positive. According to Oehme, when the mother of a child has syphilis, the following possibilities of a Wassermann reaction exist in newborns: 1) the Wassermann reaction in the mother is positive and the child is positive or negative, and 2) the Wassermann reaction in the mother is negative, and the child is positive or negative. In none of these cases can the presence of syphilis in a child be ruled out or proven. Sometimes there are fluctuations in the titer of the Wasserman reaction if antisyphilitic treatment was carried out during pregnancy. In such cases, the Neelson reaction (which immobilizes spirochetes) is recommended. A correctly taken anamnesis (abortions, premature births, polylethality, premature babies) is also of known importance for the diagnosis. The diagnosis can be confirmed by proving the presence of a spirochete in the affected tissues, skin and mucous membranes, or in the cerebrospinal fluid.

Forecast adverse. It is especially bad in the visceral type. Children often die in the first days or weeks after birth. If the intensity of the lesions is not great, they appear later, the prognosis for the child's life is good. The prognosis also depends on the moment of infection of the fetus and on the timeliness of the treatment started. If treatment is undertaken early, even in the first month after birth and is carried out systematically, recovery can be expected. No less important for the prognosis is the treatment of the mother during pregnancy. Mortality in recent years has decreased significantly (20-30%). The condition of the child, living conditions, method of feeding, etc. also play a significant role in relation to the prognosis.

Prevention. One of the most important preventive measures is the vigorous treatment of syphilis at the beginning of pregnancy. This applies to every woman who has a positive Wassermann test and has ever been infected with syphilis. Preventive treatment should also be carried out in pregnant women whose husbands have syphilis, even if they do not have signs of syphilis and the Wasserman test is negative. In cases where the Wasserman reaction in the mother becomes positive during pregnancy, the child needs to be treated prophylactically, despite the fact that apparently he seems to be completely healthy. Every pregnant woman should regularly attend a antenatal clinic, where at least twice during pregnancy, blood is examined for the Wasserman reaction. Pre-marital examination is also prophylactically justified.

Treatment. The most reliable treatment for congenital syphilis is penicillin. It is much better tolerated than arsenic and there are almost no side effects in the treatment of penicillin. The course of treatment lasts an average of 14 days. The total dose of penicillin received by the child during these 14 days is 600,000 U per kg of weight. In order to avoid the Jarisch-Herxheimer reaction (fever and an increase in clinical phenomena, the appearance of hemolytic anemia), it is recommended to prescribe only 5000-6000 U on the first day, and then gradually and rapidly increase this dose. Under the influence of penicillin treatment, syphilitic rhinitis and skin changes very quickly, even in the first days become less pronounced, bone changes disappear, the liver and spleen decrease. Pathological changes in the urine and anemia also quickly disappear, the general condition improves, toxic effects stop, the child has an appetite, he begins to suckle vigorously, gains weight and becomes calmer. The titer of the Wassermann reaction gradually falls and after 3-6-9 months after the start of treatment, this reaction becomes negative. If it continues to be positive, a second and third course of treatment with penicillin is carried out. Oehme believes that there is no need for additional treatment with arsenic preparations (neosalvarsan, spirocid) and bismuth. Proper care, natural feeding, prevention of additional infections contribute to successful treatment.

For more on symptoms and therapy, see the article Congenital Syphilis in Infants

Early congenital syphilis

According to the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10), early congenital syphilis is an intrauterine infection that occurs in a child under the age of 2 years.

There are manifest (with clinical manifestations) and latent early congenital syphilis (without clinical manifestations).

Algorithm for the diagnosis of early congenital syphilis

Study blood from the umbilical cord to the complex serological reactions.

Inspection, weighing and pathomorphological examination of the placenta.

Clinical examination (performed by a pediatrician, dermatovenereologist, neuropathologist and ophthalmologist):

a) general baby's condition (prematurity, malnutrition, Apgar score, etc.);

b) examination of the skin and mucous membranes;

c) detection of pathology of internal organs (d e pathosplenomegaly, pneumonia, etc.);

d) detection of neurological pathology;

e) changes in the fundus.

The study of cerebrospinal fluid (cytosis, protein, serological reactions, immunofluorescence reaction).

Radiography of the tubular bones of the forearms and legs (osteochondritis, periostitis).

Serological examination of the child's venous blood on the 7-8th day of life - a complex of serological reactions (microprecipitation reaction), immunofluorescence reaction, pale treponema immobilization reaction, if possible - IgM enzyme immunoassay.

Clinical signs of early congenital syphilis:

syphilitic pemphigus;

syphilitic rhinitis;

Diffuse infiltration of Hochsinger;

Roseolous papular rash;

Osteochondritis II-III degree, periostitis, osteoporosis;

Chorioretinitis;

Hepatosplenomegaly;

Pathology in the cerebrospinal fluid of a specific nature (cytosis above 20-25 cells per 1 mm 3, predominantly lymphocytic; protein above 1.5-1.7 g / l; positive results of the immunofluorescence reaction and a complex of serological reactions);

Positive results of serological reactions;

Positive results of the IgM immunoassay test;

Macroscopic and microscopic changes in the placenta (increase in the mass of the placenta, pathomorphologically - inflammatory changes in the placenta and membranes).

Early congenital latent syphilis manifests itself only serologically and accounts for more than half of all reported cases of congenital syphilis. In the first 3 months of life, the diagnosis of early congenital latent syphilis is difficult due to the fact that it is difficult to differentiate between the disease of the child and the transplacental transmission of antibodies from the mother. When making a diagnosis, the mother's history is taken into account, the degree of positivity of serological reactions in the child in comparison with the results of the mother (more pronounced positivity indicates his illness), increased positivity of the complex of serological reactions in the child after the start of treatment, positive serological tests in the determination of immunoglobulin M, pathology of the placenta.

Diagnosis of early congenital syphilis can be difficult in the presence of non-specific clinical symptoms (hepatosplenomegaly, damage to the central nervous system), when it is necessary to differentiate latent and manifest congenital syphilis. In these cases, the diagnostic value is the therapeutic effect of the specific treatment being carried out. Differential diagnosis with other diseases giving similar symptoms is necessary.

The modern approach involves carrying out all the necessary diagnostic measures and the final diagnosis within 10 days from the start of therapy, after which, according to the conclusion of the dermatovenereologist, the treatment is stopped (as a preventive one), or, if a diagnosis of early congenital syphilis is established, it continues up to 14 days as a specific . If the treatment of the child is started in the maternity hospital, then to continue therapy, the child is transferred to the children's hospital - the neonatal pathology department, the department of prematurity or another department determined in the region for hospitalization of children with congenital syphilis.

It should be borne in mind that only untreated children with manifest early congenital syphilis who have erosive or ulcerative external manifestations of syphilis on the skin and mucous membranes (for example, syphilitic pemphigus) represent an epidemiological danger to others (hospital staff). A day after the start of treatment, such children can no longer infect others, since pale treponema in the discharge of external manifestations is no longer determined. After the regression of the external manifestations of syphilis, the children can be transferred to the general ward.

Children with changes in internal organs and bones (hepatosplenomegaly, pneumonia,

Specific treatment of children with early congenital syphilis

Treatment is with one of the penicillin preparations. The daily dose of the sodium salt of penicillin in the first 6 months of life is 100,000 DB per 1 kg (body weight, after 6 months of life - 50,000 IU per 1 kg of body weight; the daily dose of drugs of medium duration (procaine-penicillin, novocaine salt of penicillin) and a single dose of durant preparations (extencillin, retarpen) - 50,000 IU per 1 kg of body weight.

The choice of the drug depends on the results of the child's cerebrospinal fluid examination: in the absence of pathology in the cerebrospinal fluid, any of the above drugs can be used; with pathological changes in the cerebrospinal fluid or if it has not been studied, durant penicillin preparations are not used.

In the absence of pathological changes in the cerebrospinal fluid:

Novocaine salt of penicillin in a daily dose divided into 6 injections every 4 hours for 14 days.

Penicillin sodium salt in a daily dose divided into 2 injections for 14 days.

For full-term children (body weight not less than 2000 g) - extencillin or retarpen 1 time per week, 3 weeks.

If there are pathological changes in the CSF or if it is impossible to perform a lumbar puncture:

Penicillin sodium in a daily dose divided into 6 injections every 4 hours for 14 days

Procaine-penicillin in a daily dose administered in one injection for 14 days.

Sodium salt of penicillin per day dose divided into 2 injections, for 14 days.

With intolerance to penicillin - oxacillin, ampicillin, ampiox in a daily dose of 100,000 IU per 1 kg of body weight, divided into 4 injections, for 10 days; ceftriaxone at a daily dose of 50 mg per 1 kg of body weight administered in one injection for 10 days.

After the end of treatment, the child is discharged under the supervision of the regional dermatovenerological dispensary, where an extract from the medical history is sent. An extract is also sent to the children's polyclinic at the place of residence indicating intrauterine infection and the child's symptoms and treatment. The diagnosis of early congenital syphilis in the extract for the district pediatrician is indicated only with written mother's consent.

Clinical and serological control of children who received prophylactic treatment is carried out in the dermatovenerological dispensary once every 3 months until the age of 1 year, after which the child is removed from the register. Clinical and serological control of children who have had early congenital syphilis is carried out up to 3 years: for 1 year - 1 time in 3 months, in the future - 1 time in 6 months. With favorable results of observation, the child is removed from the register at the age of 3 years.

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Syphilis remains one of the most common and dangerous sexually transmitted diseases in modern healthcare: congenital syphilis occupies a special place in the structure of this pathology. Despite the fact that WHO reports a significant reduction in the incidence of this intrauterine infection, doctors have to deal with this complication in their daily practice. In our review, we will consider the causes, development mechanism, clinical features, as well as the principles of diagnosis and therapy of congenital syphilis.

The essence of the problem

So what is congenital syphilis? This pathology is accompanied by transplacental transmission of the pathogen Treponema palidum to the unborn child from a sick mother. In this case, the infection of the fetus occurs both if the woman was ill before conception, and when she was infected during the bearing of the baby. Depending on the time of development, congenital syphilis is divided into early and late forms.

Early syphilitic lesions include infection of the fetus, infants (up to 1 year old) and preschool children (aged 1-4 years). The late form of the infection is distinguished by a long and almost asymptomatic course: it is diagnosed, as a rule, after four years. Separately, latent congenital syphilis is distinguished, which is diagnosed in a child only on the basis of laboratory tests.

According to Rosstat, over the past 10 years, the incidence of this infection in young children has decreased by 80%, and in adolescents by 78%. This became possible, first of all, due to the active implementation of measures to prevent congenital forms of infection. Examination of women registered with an obstetrician-gynecologist for pregnancy is carried out twice or thrice. Syphilis is detected in the early stages or in the second trimester (34% and 38%, respectively). This allows you to start adequate antimicrobial therapy in a timely manner and prevent transplacental penetration of spirochetes into the fetus.

Important! In 2013, 112 cases of congenital syphilis were registered in the Russian Federation. In 2014, the same indicator was 86 cases. Most of the sick children were born from mothers who were not observed in antenatal clinics.

Causes and mechanism of development

The main cause of congenital syphilis is the bacteria Treponema pallidum, one of the types of gram-negative spirochetes discovered in 1905 by German researchers F. Schaudin and E. Hoffmann. Pale treponema is an elongated microorganism, twisting into 8-14 curls. Its dimensions are 8-20 µm × 0.25-0.35 µm.

Due to the presence of fibrils and its own contraction, the bacterium is able to move. This ensures its rapid invasion into the human body during primary infection (usually during sexual contact). Treponema is able to maintain its pathogenicity after the infected biological fluid enters the environment, but outside the living organism, the activity of bacteria does not last long (up to drying). When heated to 60 ° C, the pathogen lives for no more than a quarter of an hour. A temperature of 100 ° C provokes instant death of spirochetes.

The peculiarity of pale treponema is that this microorganism is able to multiply only in a narrow temperature corridor (about 37 ° C). This phenomenon formed the basis of pyrotherapy of the disease: an artificial increase in body temperature to 38-38.5 ° C causes the death of most pathogens.

Congenital syphilis develops as a result of the pathogen entering the fetus. Most often, infection occurs at 16-20 weeks of gestation, when the physiological formation of the placenta is completed.

A healthy placenta is a natural barrier to foreign agents entering the blood of the unborn child. In order for the pathogen of venereal pathology to penetrate into the baby's body, pathological changes occur in the tissue of the placenta. In this case, the infection spreads to the fetus in two ways:

• Treponema palidum is introduced through the umbilical vein (as an embolus);
• Spirochetes enter the baby's lymphatic system through slits in the umbilical cord.

The negative impact of a venereal infection on the body of a pregnant woman provokes the development of the following outcomes of the disease:

• late pregnancy termination (spontaneous abortion);
• premature birth;
• stillbirth;
• the birth of children with congenital syphilis (early, late).

According to most researchers, pathomorphological processes in the child's body are associated with the influence of germ cells on the genetic material. Among the syphilitic lesions, gametopathies are distinguished (changes in germ cells that occurred before the moment of fertilization), blastopathy (damaging effect on the embryo at the time of the first stages of division), embryopathies (effect on the fetus at 4-20 weeks of gestation).

Important! The highest risk of infection in a child whose mother during pregnancy suffers from a secondary form of syphilis.

Infection of the fetus is more likely if the mother has recently had a syphilitic infection. Over the years, the ability to become a source of infection decreases. However, medicine knows cases when infected children were born from a mother who most suffered from a congenital syphilitic infection (in fact, the disease was inherited). However, such cases of hereditary syphilis in the second or third generation are more casuistry than a pattern.

Features of the classification

There are several classifications of the disease. In Russia, the division of syphilitic infection is accepted depending on its clinical and morphological manifestations and the time of onset of symptoms.

Placental injury

Defeat of a placenta at transplacental infection has primary character. When infected, it becomes enlarged, hypertrophied or hyperplastic, severe. Due to the violation of the elasticity of tissues, this organ of pregnancy looks flabby, easily torn. With syphilis, its mass can reach up to ⅓ of the weight of the fetus (at a rate of 15-20%).

Note! In more than half of the percent of cases, the detection of a heavy placenta on ultrasound indicates its syphilitic lesion.

To confirm the diagnosis, it is necessary to send biological material (a piece of placenta) for morphological examination. In this case, the cytologist will be able to determine the following pathological changes:

• puffiness;
• growing granulations;
• abscesses of the medial fibers of the villi;
• peri-endoarteritis;
• detection of pale treponemas.

Most of the degenerative-dystrophic lesions concern the germinal part of the placenta. The maternal side is affected less frequently and its changes are usually non-specific.

In addition, with the disease, changes occur in the structure of the umbilical cord (infiltration of leukocytes into the walls of arteries and veins). Also, a decrease in the volume of amniotic fluid is often observed.

Fetal syphilis

Early congenital syphilis often causes fetal pathologies. In the first months of pregnancy, the infection cannot be transmitted to the child, since the active placental circulation has not yet been established. However, pathological changes in the female reproductive system often cause malnutrition (malnutrition) and metabolic disorders in the fetus. In 60-70% of cases, this leads to fetal death and spontaneous abortion.

Starting from the 20th week of pregnancy, Treponema pallidum is able to penetrate into the baby's circulatory system, causing specific pathological changes in the body. From this point on, it is possible to diagnose fetal syphilis in case of premature birth or stillbirth if there are specific signs:

• the size and weight of the fetus differ from the standard in a smaller direction;
• symptoms of maceration are observed (skin detachment in layers, pathological joint mobility, brain melting, skull collapse);
• widespread small cell infiltration of most internal organs;
• sclerotic tissue changes;
• detection in the internal organs of a significant number of spirochetes.

And what are the morphological changes in congenital syphilis: symptoms from the internal organs are presented in the table below.

Organ	Pathological changes
Lungs	"Pneumonia alba" - specific infiltration of the pulmonary septa, exfoliation of the epithelium of the alveolar sacs. The tissue of the lungs is grayish-white in color, devoid of airiness.
Liver	Hepatomegaly: the liver is enlarged, dense, brownish-yellow, prone to fibrosis - sclerotic changes. It is possible to detect widespread foci of necrosis.
Spleen	Dense, enlarged.
kidneys	The cortical layer is affected, functional underdevelopment of the tubules and glomeruli of the kidneys is observed.
Gastrointestinal organs	Ulceration, flat infiltrates of the mucous and submucosal layer of the digestive tube.
A heart	It hits last. Perhaps the appearance of necrotic areas, foci of leukocyte infiltration are detected.
Endocrine glands	Focal or widespread cellular infiltration of the adrenal glands, pancreas, pituitary gland.
CNS	Signs of circulatory disorders of the brain, the appearance of gums of the medulla oblongata or midbrain is possible.

Another target organ affected by congenital syphilis is the bones. A child in the V-VI month of fetal development develops specific osteochondritis or osteoperiostitis mainly in the growth zones located between the epiphysis and diaphysis.

Infection in the breasts

Early congenital syphilis in children under 12 months of age has other clinical manifestations. Signs of syphilis in a newborn and infant are associated with damage to all internal organs and systems. A sick child has a typical appearance:

• dry and wrinkled, like senile skin;
• areas of hyperpigmentation on the face and body;
• disproportionately large head with pronounced frontal tubercles;
• clearly visualized subcutaneous venous network;
• seborrheic crusts on the head;
• deeply sunken bridge of the nose;
• thin and elongated limbs;
• restlessness and disturbing sleep of the baby, frequent and loud cry;
• delayed psychomotor development;
• violations of the simplest unconditional acts (sucking, breathing, swallowing);
• severe dystrophy, low percentage of subcutaneous fat, bedsores.

Often, signs of congenital syphilis in newborns are accompanied by characteristic skin symptoms. Manifestations of syphilitic lesions of the epidermis are observed in 70% of cases.

Syphilitic pemphigus of the newborn is a symptom pathognomonic for the congenital form of the disease. It is determined immediately after the birth of the child or appears after a few days. It is characterized by the formation of blisters on the skin, which have several distinctive features. Firstly, they are located mainly on the palmar and plantar surfaces of the limbs, the face. Secondly, their size is relatively small, ranging from 5 to 10-15 mm. The bubbles have a dense tire, a bright scarlet base, and inside them a transparent serous (less often hemorrhagic) fluid is produced, containing a large number of pathogens (spirochetes).

Formations in syphilitic pemphigus can spontaneously open. This leads to the exposure of infiltrated hyperemic erosion, which dries up after a few days with the formation of a brown-red crust.

Important! Newborns and infants with congenital syphilis die without treatment within 5-8 months.

Signs of illness in preschoolers

Symptoms of congenital syphilis in children under 4 years of age are mild. Usually not the whole body is affected, but two or three separate systems. Skin manifestations are considered specific:

• weeping large papular rashes on the skin of the inguinal region, perineum, natural folds, less often on the face and scalp;
• erosive warts, merging with each other;
• pustules with an eroded nodule in the center, localized mainly on the mucous membrane of the gums, tonsils, tongue, and also in the corners of the mouth.

In addition, this form of the disease is characterized by the appearance of signs of syphilitic laryngitis (hoarseness of voice, sore throat), rhinitis (atrophic runny nose, sometimes destruction of the vomer and nasal septum), baldness, lymphadenitis, lesions of the musculoskeletal system (periostitis of the fingers, phalangitis) .

Damage to the central nervous system is accompanied by a lag in the child's mental and motor development, convulsive seizures, hydrocephalus, and sluggish inflammation of the meninges. Often the disease proceeds with pathomorphological changes in the organ of vision (optic nerve atrophy and blindness, keratitis and choreoritinitis).

Important! Diagnosis of the congenital form of infection in early childhood is usually not difficult, since standard serological tests in such patients are sharply positive.

Late syphilitic lesion

Clinical signs of this form manifest themselves no earlier than 4-5 years of a child's life. According to statistics, most patients experience symptoms of this form at the age of 14-15 years.

In many children with a late course of the pathology, signs of an early form of the disease are asymptomatic. Others show typical pathomorphological changes (deformation of the brain or facial skull, saddle-shaped nose).

In general, the clinical picture of the disease does not differ from tertiary syphilis. In children and adolescents, multiple multiple organ disorders, visceropathy, diseases of the nervous system and endocrine glands are observed.

Specific symptoms that reliably indicate a congenital syphilitic lesion that has developed in a child include:

• parenchymal keratitis (pronounced clouding of the cornea, lacrimation, photophobia);
• dental dystrophy (hypoplasia of the incisors, the presence of sickle-shaped and semilunar recesses on the molars);
• labyrinthitis (deafness caused by degenerative lesions of both auditory nerves).

Possible signs of a late infection include gonitis (chronic inflammation of the knee joints), periostitis and osteoperiostitis, "saber" shins, saddle nose (significant protrusion of the nostrils forward due to deformation of the bones of the skull), buttock-shaped skull, dystrophy of molars, various lesions of the nervous system (mental retardation, dysarthria, hemiparesis, and Jacksonian epilepsy).

In addition, the so-called stigmas, signs of a dystrophic lesion of the intrasecretory, nervous and cardiovascular systems, can indicate a late congenital form of a sexually transmitted disease. Among them are:

• "Gothic" palate;
• changes in the structure of the facial and cerebral skull - intensely protruding forward tubercles in the frontal and parietal sections;
• additional protrusion on the inner-lateral surface of the teeth of the molars (tubercle of Carabelli);
• axifoidia - underdevelopment of the xiphoid process of the sternum;
• shortening of the little finger.

Often in babies with congenital syphilis, a symptom such as hypertrichosis is observed. It can develop in both boys and girls, and from a very early age. It is characterized by excessive hair growth of the skin of the extremities, chest, back, buttocks. Often there is a complete overgrowth of hair on the forehead, cheeks, chin.

Diagnostic principles

In the diagnosis of the congenital form of infection, knowledge of the clinical and pathomorphological features of the disease plays an important role. To confirm the doctor's guesses, standard serological tests are usually used, which are effective in 100% of cases with an early form of the disease, and in 90-92% of cases with a late one.

In addition to laboratory tests, the following are of great diagnostic value:

• lumbar puncture (in the presence of neurological symptoms);
• R-graphy of bones and joints;
• expert advice:
  • pediatrician;
  • ophthalmologist;
  • ENT doctor;
  • neuropathologist;
  • infectiologist.

During the diagnosis of infection in a child, it is important to simultaneously examine his mother and other close relatives. At the same time, blood sampling from a woman 2 weeks before and 2 weeks after childbirth is not recommended due to insufficient information content of the results. For high diagnostic value, the serological examination of a woman and a newborn should be comprehensive and include the Wasserman reaction, RIBT and RIF.

Note! To examine older children and adolescents with suspected congenital syphilis, RIF (immunofluorescence reaction) or RIBT (treponema pallidum immobilization reaction) should be used. They show a positive result in almost all patients.

Current approaches to therapy

Treponema pallidum is a unique microorganism, despite the long history of the use of penicillins, which has retained high sensitivity to antibiotics of this group. Therefore, the main method of antimicrobial therapy for syphilis remains the long-term and systematic administration of therapeutic doses of penicillin derivatives:

• water-soluble - benzylpenicillin (potassium, sodium salt);
• medium duration - novocaine salt of benzylpenicillin, Bicillin, Procainepenicillin;
• high duration - BBP (dibenzylethylenediamine salt of benzylpenicillin).

The preferred method of maintaining a constant therapeutic concentration of an antibiotic in the body is its regular intravenous or intramuscular administration. When taken orally, the drug is absorbed into the blood much worse. If a child is diagnosed with a syphilitic lesion of the nervous system, injections of the drug should be combined with its endolumbar administration, as well as pyrotherapy (creating artificial hyperthermia), which improves the passage of penicillins through the blood-brain barrier.

If a child is intolerant to penicillin antibiotics or has a history of allergic reactions, alternative treatment regimens with Erythromycin and other macrolides, as well as tetracycline derivatives, are used. The use of cephalosporins is not recommended due to possible cases of cross-allergy. Also contraindicated for monotherapy are aminoglycosides (effective against treponema pallidum only in very high doses that are toxic to the child) and sulfonamides (the pathogen shows high resistance in their respect).

The prognosis of the disease is largely determined by the timeliness of seeking medical help. Early screening diagnosis of venereal pathology in a pregnant woman makes it possible to prevent infection of the fetus, and the treatment of congenital syphilis with effective antibiotics significantly reduces the risk of complications.

Due to the intensive course of antimicrobial therapy, most children with congenital syphilis recover completely by the end of the first year of life. However, neglected damage to most internal organs in the late form of the disease can have serious health consequences.

Prevention measures

The medical examination system, actively developed by WHO at the end of the 20th century, made it possible to significantly reduce the number of cases of registration of patients with congenital syphilis. They played a big role in this:

• mandatory registration of all patients with syphilis (special attention is paid to women of reproductive age);
• early detection and timely initiation of treatment of persons-sources of infection;
• therapy based on the principles of a guaranteed volume of free and high-quality medical care;
• two- or three-time prophylactic for all expectant mothers, as well as workers in the food industry, kindergartens;
• close connection in the work of LCDs, maternity hospitals, pediatric departments of polyclinics and dermatovenerological dispensaries.

Laboratory diagnosis of syphilis in pregnant women is carried out at the beginning (at the time of registration in the antenatal clinic) and at the end (for a period of 30-32 weeks) of pregnancy. If, during the examination, this venereal infection in an active or latent form was detected in the expectant mother, she is prescribed a full course of antimicrobial therapy. If a history of syphilis is indicated, the woman is also undergoing prophylactic antibiotic treatment, even if she has already successfully completed therapy. Injections of penicillin derivatives in this case are necessary to prevent the recurrence of the disease and the birth of a healthy baby.

Important! Children born to mothers who have been infected with treponema pallidum should be under the supervision of medical professionals until they reach 15 years of age. This will allow them to be diagnosed as early as possible with signs of early and late congenital syphilis in the event of its development.

In the case of a positive result of serological tests during pregnancy, two weeks after birth, the diagnosis of syphilis in the mother is repeated. It is also necessary to carefully examine the newborn. In the event that a venereal infection is detected, both should begin a course of antisyphilitic treatment as early as possible.

Thus, the prevention of congenital syphilis consists not only in preventing the development of infection through health education among people of reproductive age, promotion of protected sex and the use of condoms, but also in the early detection of a sexually transmitted disease in a pregnant woman. Timely seeking medical help will prevent the development of serious irreversible changes in the body of the fetus and will allow you to give birth to a strong and healthy child.

Congenital syphilis occurs when a child is infected before birth, in the womb. This problem is still very important for venereology: a common cause of miscarriages or death of newborns is precisely syphilis, with which the mother infected the child during the gestation period.

Over the past ten years, the number of pregnant women suffering from syphilis has increased by 1.5 times. This is due to the fact that the latent form of syphilis is very common today. But the statistics are also influenced by the fact that testing of women in labor for syphilis has become mandatory - and today more such women are being detected than before.

In Russia, they try to strictly control the health status of pregnant women: they are provided with free observation in the antenatal clinic, as well as hospitalization in the maternity hospital or in the pregnancy pathology department, if necessary. But alas, there remains a large percentage of unexamined women who register too late, or do not register at all. As a result, the belated detection of syphilis in pregnant women becomes the main cause of syphilis in newborns.

What is dangerous for a child is congenital syphilis, how to save an unborn baby and protect him from the consequences - we tell in this article.

Syphilis and pregnancy

If pale treponemas - the causative agents of syphilis - are present in the mother's body, then they can pass to the child. This is possible when the placenta begins to work actively in the uterus of a pregnant woman (it provides the fetus with blood and performs other tasks). Syphilis bacteria penetrate the placenta, damage it, and further along the umbilical cord (through lymph or blood) get to the fetus.

Consider exactly how pale treponema infects a child at different times and what threatens him.

Fetal infection and risks

Syphilis is transmitted to a child after 7-8 (and according to some reports after 11-13) weeks of intrauterine development. But the disease itself does not develop until 16 weeks.

This is due to the fact that before the 16th week, the fetal defense system is not yet developed and (unlike an adult) the child's body does not respond to syphilis with inflammation, from which its organs could suffer. Therefore, if treatment is started before the 16th week of pregnancy, then most often doctors manage to prevent syphilitic damage to the fetus.

The risk of infecting a child with syphilis during pregnancy depends on many factors.

If you start treatment before the 16th week of pregnancy, then doctors will have time to protect the baby from syphilis

Most at risk of transmitting syphilis to a child:

• pregnant women with secondary active syphilis (who have visible signs of infection on the skin - spots of various colors and sizes, ulcers or nodules);
• pregnant women with secondary latent syphilis (who were infected less than two years ago and who have no visible signs of the disease) are at slightly less risk;
• pregnant women who were first diagnosed with syphilis in late pregnancy (in the third trimester);
• pregnant women with syphilis who do not follow a strict treatment regimen.

More details about the course of pregnancy with syphilis can be found in the material "Syphilis during pregnancy".

What are the chances of saving the child?

The chances of saving a child from syphilis directly depend on the trimester in which treatment began. In such a situation, the pregnant woman is consulted by two specialists at once - a dermatovenereologist and an obstetrician-gynecologist. They assess the condition of the fetus and give a further prognosis (what are the prospects for treatment).

The decision to have an abortion or continue the pregnancy until the end of the second trimester (28 weeks) is up to the woman herself. Fully carried out treatment in the first and second trimesters, as a rule, allows you to give birth to a completely healthy baby.

If syphilis was detected in the third trimester (after 28 weeks), then abortion is allowed only if the fetus has signs of congenital syphilis, confirmed by ultrasound. If they are not, then the pregnancy is maintained regardless of the desire of the woman.

Manifestations of congenital syphilis

The baby becomes infected in the womb, but syphilis can manifest itself at different periods of the child's life: before birth, immediately after or after a few years. Depending on this, there are:

• syphilis of the fetus, which leads to his death, and as a result - miscarriage or stillbirth;
• early congenital syphilis - when the disease manifests itself right after birth or in the first two years of life;
• late congenital syphilis - when the disease manifests itself after two years of life.

Early congenital syphilis

Early congenital syphilis in children has a variety of symptoms, among which are:

• specific (characteristic) signs of syphilis, which occur only in congenital form;
• common signs of syphilis for both congenital and acquired forms;
• non-specific (occur in various diseases) signs that occur with many intrauterine infections.

Specific signs of early congenital syphilis:

1. syphilitic pemphigus

This is a collection of blisters with clear, yellow, green (purulent) or red (bloody) contents. A reddish-purple rim can be seen around the bubbles. The bubbles burst easily, exposing the tissue underneath.

When appears: from the moment of birth or in the first days of life;

Where is located: on the palms and soles, less often on other areas of the skin.

2. Diffuse skin infiltration

It is a thickening of the skin. It becomes "tense", shiny, often cracks appear on the skin. Then they heal and leave behind small scars. Small radiant scars around the mouth are called Robinson-Fournier scars - they remain for life. This is a sign of syphilis in early childhood.

When appears: by the end of the second month, at 8-10 weeks of life;

Where is located: palmar and plantar surface of the extremities, face (often around the mouth), hair growth zone, less often - thighs, buttocks.

3. Syphilitic rhinitis

Manifested as a "runny nose" - at best; or as destruction of the cartilaginous and bony parts of the nose, at worst.

Specific rhinitis, or inflammation of the nasal mucosa, has three stages:

• nasal congestion (and swelling of the mucosa);
• nasal discharge (clear, purulent, or bloody);
• the appearance of ulcers on the nasal mucosa.

When appears: from the first days of life

Without treatment, ulcers move to the cartilaginous and even bony parts of the nose, causing their deformation (the so-called saddle nose, goat nose).

Wegener's osteochondritis

Disease of tubular bones (shins, hips, shoulders, forearms, etc.). The lesion occurs in the bone growth zone - calcium cannot be formed in it.

In the disease, 3 stages are also distinguished, which are determined by x-rays. In the later stages of the disease, one part of the bone (pineal gland) may even begin to separate from another (diaphysis), and then an internal fracture will occur. In this case, the limb loses mobility, and if you move it forcibly, there is a sharp pain. This complication is called Parro's pseudoparalysis;

Signs of acquired and congenital syphilis:

of all cases of syphilis
This is intrauterine infection.

• roseolous (spots) or papular (nodules) rash;
• wide warts (a special type of warts) in the anus;
• alopecia (baldness);
• changes in cerebrospinal fluid (neurosyphilis);
• disease of internal organs (visceral syphilis);
• syphilis of the musculoskeletal system (periostitis, osteosclerosis).

Nonspecific (common for different diseases) signs of congenital syphilis:

• anemia (anemia);
• enlargement of the liver;
• enlargement of the spleen;
• malnutrition (insufficient body weight, exhaustion);
• visual impairment (chorioretinitis).

Late congenital syphilis

If in the first 2 years of a baby's life, congenital syphilis lived hidden in the body, and the child did not receive the necessary treatment, then late congenital syphilis develops. Signs of late congenital syphilis are divided into reliable and probable.

Reliable signs of late congenital syphilis include Hutchinson's triad:

• defect of the teeth - "Hutchinson's teeth"

This is a change in the shape of the incisors into rounded or barrel-shaped with semilunar notches on the cutting edge. The upper incisors are more often deformed, but the lower incisors may also be affected. This sign of congenital syphilis occurs in 17-18% of cases;

• hearing loss - "labyrinthine deafness"

This is a lesion of the labyrinth - part of the inner ear, which leads to hearing loss or complete deafness. This symptom of congenital syphilis occurs in 3-4% of cases;

• eye damage - "parenchymal keratitis"

This is a lesion of the cornea (the outer shell of the eye), due to which it becomes cloudy, there is a spasm of the eyelids, lacrimation, redness of the whites of the eyes and photophobia. This symptom of a congenital disease occurs in 50% of cases.

Possible signs of illness in congenital syphilis:

• saber-shaped shins - curved forward, modified shins;
• Robinson-Fournier scars - scars from a previously transferred skin lesion;
• buttock-shaped skull - a modification of the skull due to hydrocephalus;
• Olympic forehead - enlargement of the frontal lobes of the skull;
• various dental dystrophies - malnutrition of dental tissues. Because of this, large distances between the upper incisors, additional elevations on the chewing surface of the teeth, cystic deformations, etc. may occur;
• spider fingers - elongated fingers with large interphalangeal joints.

If congenital syphilis first manifests itself after five years of a child's life, then it proceeds with symptoms of "classic" late syphilis. Those. its main manifestations will be bumps and gummas (bumps) that occur in various places in the body.

What will happen to the newborn if he received treatment

If the diagnosis of syphilis was made in a timely manner, and the newborn received full treatment in the first month of life the chances of recovery are very high.

Early treatment of syphilis in newborns often gives a good effect and avoids serious consequences. Babies born with syphilis can be breastfed if mom and baby are treated at the same time. Medicines for syphilis safe, both for the baby in the womb and for the already born.

If the diagnosis was made late or the treatment was carried out incorrectly, then a congenital infection can turn into serious consequences for the child.

Failure to prevent, diagnose, and treat congenital syphilis can result in:

Hereditary syphilis - truth or myth?

Syphilis is an infectious disease caused by bacteria. It is not inherited, human genes do not affect it in any way. You can become infected with syphilis only through contact with a bacterium: during sex, kissing, during pregnancy, blood transfusion, etc.

Syphilis is not transmitted through genes. If a person is completely cured of syphilis, nothing threatens his offspring!

Prevention of congenital syphilis

The main thing for the prevention of congenital syphilis is to detect the infection in a timely manner. Young women need to remember:

• When pregnant, you need to register no later than 12 weeks. During the registration, a pregnant woman is supposed to pass at least 3 blood tests for syphilis: at the first visit to the gynecologist, at 30 weeks of pregnancy and at the maternity hospital - immediately before childbirth.
• If a woman has ever been diagnosed with syphilis, the past diagnosis should be reported to the doctor - regardless of whether treatment was carried out at that time. Perhaps the doctor will prescribe preventive treatment.
• If a woman suspects that she has contracted syphilis already during pregnancy, then it is imperative to consult a doctor - no need to wait for the first symptoms to appear! Primary syphilis is not very dangerous to the fetus until it becomes secondary. If you start treatment immediately in the primary period, then the risk of infecting the fetus will be reduced to zero.
• If the doctor has confirmed syphilis, then for the period of treatment it is necessary to refrain from any sexual contact (even with a condom!). Both partners should be treated at the same time - even if one of them is "healthy" according to the tests, as well as children, if they are in the family.

If you follow these simple rules, then the threat can be avoided.

Congenital syphilis is a serious threat to the health and life of a child, but do not despair. Syphilis is treatable, and drugs for it are quite safe for the fetus and infant. The best chances to protect the baby from infection are in those women who discovered syphilis at the beginning of pregnancy and quickly began treatment. More serious risks are in those who have diagnosed the disease after the 16th week of pregnancy; the later, the more dangerous.

• What is congenital syphilis
• Symptoms of congenital syphilis
• Treatment of congenital syphilis
• Which Doctors Should You See If You Have Congenital Syphilis

What is congenital syphilis

congenital is called syphilis, which is transmitted to the unborn child transplacentally through the mother's blood. Congenital syphilis is early and late.

TO early congenital syphilis include fetal syphilis, infancy syphilis, and early childhood syphilis.

Late congenital syphilis usually comes to light after 15-16 years, and until then does not manifest itself in any way. However, sometimes the symptoms of late congenital syphilis appear starting from the third year of life.

What Causes Congenital Syphilis

congenital syphilis develops when pale treponema enters the fetus through the umbilical vein or through the lymphatic clefts from a mother with syphilis. The fetus can become infected in case of illness of the mother before pregnancy, as well as at different stages of its development. Pathological changes in the organs and tissues of the fetus develop in the V-VI months of pregnancy, i.e. during the development of placental circulation.

Pathogenesis (what happens?) during congenital syphilis

According to a number of scientists, a syphilitic infection can also affect the chromosomal apparatus of the germ cells of the parents. There are syphilitic gametopathies (degenerative changes that occurred in germ cells before fertilization), blastopathies (damage to the embryo during blastogenesis) and syphilitic embryopathies (pathological changes in the fetus in the period from 4 weeks to 4-5 months of pregnancy). In such sick children, a variety of defects of a physical, neurological and mental, intellectual nature are found.
Congenital syphilis occurs when Treponema pallidum enters the fetus through the placenta from a mother with syphilis. Infection of the fetus can occur both in the case of maternal illness before conception, and later, at different stages of fetal development. Pale treponemas enter the fetus through the umbilical vein or through the lymphatic clefts of the umbilical vessels. Despite the early penetration of pale treponema into the fetal body, pathological changes in its organs and tissues develop only in the 5th-6th months of pregnancy. Therefore, active antisyphilitic treatment in early pregnancy can ensure the birth of healthy offspring. Since secondary syphilis occurs with symptoms of spirochetemia, the risk of having a sick child in pregnant women with secondary syphilis is greatest. In addition, the transmission of syphilis to offspring occurs mainly in the first years after infection of the mother; later this ability gradually weakens. It is considered possible to give birth to children with syphilis from a mother suffering from congenital syphilis (syphilis of the second and even third generation). However, such cases are very rare. The outcome of pregnancy in a woman with syphilis is different: it can end in a late miscarriage, premature birth, the birth of sick children with early or late manifestations of the disease, or a latent infection. Women with syphilis are characterized by a different outcome of pregnancy at different stages of the process, since the degree of infection of the fetus depends on the activity of the infection. The possibility of infection of the fetus by transmission of the infection through the sperm from the father has not yet been proven.

Symptoms of congenital syphilis

Depending on the clinical symptoms, the characteristics of the course of the disease and the timing of its manifestation, congenital syphilis is divided into fetal syphilis, early congenital syphilis (from birth to 4 years), late congenital syphilis (in children older than 4 years), latent congenital syphilis observed during all age groups.

Classification of congenital syphilis
Traditional classification of congenital syphilis:
1. Fetal syphilis.
2. Syphilis in infants (up to 1 year).
3. Syphilis of early childhood (from 1 year to 4 years).
4. Late congenital syphilis (from 4 years and older).
5. Hidden congenital syphilis (occurs in infants and aged 1 year and older).

According to the international classification adopted by the XXIX World Health Assembly, congenital syphilis is divided as follows:
- early congenital syphilis with symptoms in children under 2 years of age;
- latent early congenital syphilis (no clinical manifestations, positive serological reactions, cerebrospinal fluid without pathology) in children under 2 years of age;
- early congenital syphilis, unspecified.

According to the international statistical classification of diseases, there are:
- early congenital syphilis (infection period up to 2 years);
- late congenital syphilis with a disease duration of more than 2 years from birth;
- unspecified congenital syphilis.

Early congenital syphilis (infection period up to 2 years):
1. Early congenital syphilis with symptoms(any congenital syphilitic condition, both early and manifested before the age of 2 years):
- early congenital syphilis of the skin;
- early congenital syphilis of the skin and mucous membranes;
- early congenital syphilis visceral;
- early congenital syphilitic laryngitis;
- early congenital syphilitic ophthalmopathy;
- early congenital syphilitic osteochondropathy;
- early congenital syphilitic pharyngitis;
- early congenital syphilitic pneumonia;
- early congenital syphilitic rhinitis.
2. Early congenital syphilis latent(congenital syphilis without clinical manifestations with a positive serological reaction and a negative test of cerebrospinal fluid in children under 2 years of age).
3. Early congenital syphilis, unspecified(congenital syphilis without bacteriological or histological confirmation in a child under 2 years of age; i.e., the diagnosis is established in the absence of a full examination of the child or if the clinical picture of the examination does not make it possible to judge the degree of specificity of the existing pathology).

Syphilis of the placenta
The placenta affected by syphilis is enlarged, hypertrophied, flabby, fragile, easily torn, heavy. Its mass is 1/4-1/3 of the mass of the fetus (normally 1/6-1/5). According to statistics, on average, up to 50% of cases of severe placenta are associated with congenital syphilis. To confirm the diagnosis of placental syphilis, a histological examination is necessary. With a syphilitic lesion in the germinal part of the placenta, edema, proliferation of granulation cells, damage to the central part of the villi (abscesses) and blood vessels (mainly peri- and endoarteritis) are detected, pale treponemas are detected. Histological changes in the maternal part of the placenta are rare, they are less pronounced and do not have a specific character. Pale treponemas are rarely found, which is explained by intensive processes of phagocytosis. Specific septicemia and pale treponema are determined in various organs of the fetus (liver, spleen, adrenal glands), umbilical cord, less often in the blood and placenta. More permanent are changes in the umbilical cord, which are manifested by leukocyte infiltration of the walls of blood vessels, especially the muscle layer (endo-, meso-, perivasculitis), with predominant localization in the umbilical vein. Often there is a change in the amount of amniotic fluid (more often a decrease), which leads to a disruption in the development of individual organs and systems, in particular the nervous system.

A reliable sign of syphilis is the presence of pale treponema in the umbilical cord, where they are found in large numbers in almost all cases of congenital syphilis, and in the placenta.

If syphilis is suspected in a parturient woman, it is necessary to conduct a microscopic examination of the fetal end of the umbilical cord for pale treponema in a dark field of vision. If this is difficult in the maternity hospital, it is necessary to cut off the peripheral end of the umbilical cord 5 cm long from the fetal end, place it in a sterile tube and send it to the laboratory for examination for pale treponema. Women with untreated syphilis are characterized by late miscarriages, cases of stillbirth (fetus with signs of maceration) in the VI-VII months of pregnancy. Often, with fetal syphilis, no specific changes are found in the placenta, which is explained by the effect of antisyphilitic treatment or infection of a woman with syphilis during pregnancy. At the birth of a child with clinical symptoms of syphilis, pale treponemas are quite often found in the fetal and maternal parts of the placenta, even in the absence of visible manifestations of syphilis in the mother.

Fetal syphilis
As a result of the defeat of the syphilitic infection of the placenta, the nutrition of the fetus, metabolism are disturbed and intrauterine death occurs, followed by miscarriage of the fetus. In the first months of pregnancy, pale treponemas in the fetus may not be detected, as they penetrate into his body with the development of placental circulation.

Starting from the 5th month of pregnancy, miscarriages, premature births and stillbirths show signs characteristic of syphilis:
- the fetus has a small size, low body weight; signs of maceration;
- in the lungs, liver, kidneys, spleen and endocrine glands, specific lesions are detected, manifested by diffuse small cell infiltration, proliferation of connective tissue, changes in the walls of blood vessels;
- in the tissues of internal organs, pale treponemas are found in large numbers.

Lungs. A typical lesion of the lungs (“white pneumonia”, “pneumonia alba”) is also characteristic - focal or diffuse specific infiltration of the interalveolar septa, hyperplasia and desquamation of the alveolar epithelium, fatty degeneration and filling of the alveoli with it. Lung tissue is airless, grayish-white.

Liver. Enlarged, dense, with a smooth surface. Small cell infiltration and small foci of yellowish necrosis are found, and atrophy of the organ often develops. On the section, the liver tissue is dull, yellow-brown, pronounced sclerotic changes are noted.

Spleen. Usually enlarged, compacted.

Kidneys. The cortical layer is most often affected. Underdeveloped glomeruli and tubules, cysts, diffuse small cell infiltration are revealed.

Digestive tract. In the mucous and submucosal layer of the stomach and intestines (usually thin), flat infiltrates, ulcerated in places, are noted.

A heart. Rarely affected. Foci of cell infiltration, swelling of cells around the vessels, necrotic areas are revealed.

Endocrine glands. The adrenal glands are more often involved in the pathological process, then the pancreas, the pituitary gland, and the sex glands. There is focal or significant diffuse infiltration with areas of necrosis.

Central nervous system. Inflammatory changes are revealed, which are manifested by productive leptomeningitis with vascular sclerosis, meningoencephalitis, granular ependymatitis. Quite often gummas of a medulla oblongata develop.

The most frequent and reliable sign of fetal syphilis is the detection of specific osteochondritis of I, II, III degrees or osteoperiostitis with predominant localization at the ends of long tubular bones in the growth zone (on the border between the diaphysis and epiphysis) during X-ray examination at the V-VI months of intrauterine development.

Congenital syphilis of infants (syphilis congenita praecox).
Many organs and systems are involved in the pathological process, which leads to a variety of symptoms.

Characteristic appearance of the child:
- “senile”, dry, wrinkled face;
- the head is large, with developed frontal tubercles and an abundant venous network, often covered with seborrheic crusts;
- sunken bridge of nose;
- areas of pigmentation are often noted on the face;
- the skin is pale, flabby, dirty yellow;
- limbs are thin, cyanotic;
- the child is restless, cries continuously, sleeps anxiously, often at night or with sudden movements emits a piercing cry, which is associated with damage to the central nervous system;
- the child develops poorly, quickly loses weight;
- persistent runny nose (difficulty breathing and sucking) is detected;
- there are phenomena of dystrophy with an almost complete absence of subcutaneous fatty tissue (bedsores may form).
Often (up to 70% of cases) skin lesions are observed.

Pemphigus syphilis (pemphigus syphiliticus)
Syphilitic pemphigus is one of the reliable signs of syphilis, existing already at the birth of a child or appearing in the first days of his life.

The following clinical symptoms are characteristic of syphilitic pemphigus:
- blisters are located mainly on the palms and soles, as well as on the face, flexor surfaces of the forearms and shins, less often all over the skin;
- the size of the bubbles - from a pea to a cherry;
- bubbles usually do not merge;
- the tire of bubbles is dense;
- the base of the bubble is hyperemic, infiltrated;
- the contents are serous or serous-purulent, less often hemorrhagic;
- a large number of pale treponemas are found in the contents;
- after the opening of the blisters, red infiltrated erosions are formed, the discharge from the surface of which subsequently dries up, and brownish crusts form;
- often before the appearance of blisters, spotted and papular rashes appear.

In the absence of antisyphilitic treatment, children die.

Congenital syphilis of early childhood, syphilis of early childhood (from 1 year to 4 years) (syphilis congenita praecox)
Usually, only individual organs and systems are involved in the pathological process. Mild clinical symptoms are characteristic, as in secondary recurrent syphilis. Limited large papules appear on the skin in the genital area, anus, inguinal folds, interdigital folds of the feet, often weeping, vegetating. They may coalesce to form broad warts that erode or ulcerate. In weakened children, papules and pustules may appear on the scalp and face. Roseolous rashes are rare. Localized on the mucous membranes of the mouth, tongue, pharynx, tonsils, gums, papular rashes take the form of eroded opal nodules. Due to constant maceration in the corners of the mouth, they resemble banal jams. When nodules appear on the mucous membrane of the larynx, papular rashes merge and form a diffuse papular infiltration, which is clinically manifested by a hoarse, hoarse voice, aphonia, and sometimes stenosis of the larynx. Sometimes there is syphilitic rhinitis, causing atrophic catarrh and often perforation of the nasal septum. Diffuse or focal specific alopecia may be observed. Slightly enlarged lymph nodes, often ulnar on both sides. Gummas rarely occur. In 60% of children, damage to the skeletal system is characterized by limited periostitis, osteoperiostitis, and osteosclerosis phenomena with frequent localization in the area of ​​long tubular bones, which is detected only by X-ray examination. Diffuse periostitis of the fingers, metacarpal bones (bottle-shaped phalangitis) is often noted. Much less often bone gummas are formed. Sometimes there is an increase and thickening of the liver, spleen, the phenomenon of nephronephritis. Often the testicles are affected, which increase, become dense, bumpy. Damage to the nervous system is manifested by mental retardation, epileptiform seizures, hydrocephalus, hemiplegia, meningitis. Rarely, tabes can begin. Possible eye damage (choreoritinitis, optic nerve atrophy, parenchymal keratitis). Standard serological tests in most children are positive.

Late congenital syphilis (syphilis congenita tarda)
Clinical symptoms occur not earlier than 4-5 years of age, can be observed in the 3rd year of life, but more often - at 14-15 years, and sometimes later. In most children, early congenital syphilis is asymptomatic (early latent congenital syphilis) or even early latent syphilis may be absent, others show changes characteristic of early congenital syphilis (saddle nose, Robinson-Fournier scars, skull deformity). With late congenital syphilis, tubercles, gummas appear on the skin and mucous membranes, numerous visceropathy, diseases of the central nervous system, and endocrine glands are noted. The clinical picture of late congenital syphilis does not differ from that of the tertiary period of syphilis. Diffuse hardening of the liver is noted. Gummatous nodes may appear much less frequently. Possible damage to the spleen, as well as nephrosis, nephronephritis. When the cardiovascular system is involved in the pathological process, heart valve insufficiency, endocarditis, and myocarditis are detected. There is evidence of damage to the lungs, digestive tract. Typical is the defeat of the endocrine system (thyroid gland, adrenal glands, pancreas and gonads).

The characteristic features of the clinical picture of late congenital syphilis are specific symptoms, which are divided into unconditional (reliably indicate congenital syphilis) and probable (require additional confirmation of the diagnosis of congenital syphilis). There is also a group of dystrophic changes, the presence of which does not confirm the diagnosis of syphilis, but which should be excluded.

Unconditional symptoms
Parenchymal keratitis (keratitis parenchymatosa). As a rule, one eye is initially involved in the pathological process, after 6-10 months - the second. Regardless of treatment, there are signs of parenchymal keratitis (diffuse corneal opacity, photophobia, lacrimation, blepharospasm). Clouding of the cornea is more intense in the center and often develops not diffusely, but in separate areas. The corneal and conjunctival vessels were dilated. Visual acuity decreases and often disappears. At the same time, other eye lesions can be observed: iritis, chorioretinitis, optic nerve atrophy. The prognosis for the restoration of vision is unfavorable. Almost 30% of patients have a significant decrease in visual acuity.

Dental dystrophies, Getchinson's teeth (dentes Hutchinson). First described by Getchinson in 1858 and are manifested by hypoplasia of the chewing surface of the upper middle permanent incisors, along the free edge of which semilunar, crescent-shaped notches are formed. The neck of the tooth becomes wider ("barrel" teeth or in the form of a "screwdriver"). There is no enamel on the cutting edge.

Specific labyrinthitis, labyrinth deafness (surditas labyrinthicus). It is observed in 3-6% of patients aged 5 to 15 years (more often in girls). Due to inflammation, hemorrhages in the inner ear, degenerative changes in the auditory nerve, deafness suddenly occurs due to damage to both nerves. In the case of development up to 4 years of age, it is combined with difficulty in speech, up to dumbness. Bone conduction is impaired. It is resistant to specific therapy.

It should be noted that all three reliable symptoms of late congenital syphilis - the Getchinson triad - are quite rare at the same time.

Likely Symptoms
They are taken into account in the diagnosis, subject to the identification of other specific manifestations, anamnesis data and the results of an examination of the patient's family.

specific drives, first described by Cletton in 1886, occurs in the form of chronic synovitis of the knee joints. The clinical picture of the defeat of the cartilage of the epiphyses is absent. On examination, an increase in the joint, its swelling, limited mobility, and painlessness are noted. Perhaps symmetrical damage to another joint. Often, the elbow and ankle joints are involved in the pathological process.

Bones are often affected with a predominance of hyperplastic processes in the form of osteoperiostitis and periostitis, as well as gummy osteomyelitis, osteosclerosis. Destruction of a bone in combination with processes of a hyperplasia is characteristic. Due to inflammation, increased bone growth occurs. Quite often, a symmetrical lesion of long tubular bones, mainly tibia, is noted: under the weight of the child, the tibia bends forward; “saber-shaped shins” (tibia syphilitica) develop, which is diagnosed as a consequence of syphilitic osteochondritis transferred in infancy. As a result of the transferred syphilitic rhinitis, underdevelopment of the bone or cartilaginous parts of the nose is noted, characteristic deformations of the organ occur.

saddle nose observed in 15-20% of patients with late VS. Due to the destruction of the nasal bones and the nasal septum, the nostrils protrude forward.

Goat and lornet nose is formed as a result of small cell diffuse infiltration and atrophy of the nasal mucosa, cartilage.

Buttock-shaped skull. The frontal tubercles stand as if separated by a furrow, which occurs due to syphilitic hydrocephalus and osteoperiostitis of the skull bones.

Dystrophic lesions of the teeth. On the first molar, atrophy of the contact part and underdevelopment of the chewing surface are noted. The shape of the tooth resembles a pouch (moon tooth). The chewing surface can also be changed on the 2nd and 3rd molars (Moser and Pfluger teeth). Instead of a normal chewing tubercle, a thin conical process (Fournier's pike tooth) forms on the surface of the canine.

Robinson-Fournier radial scars. Around the corners of the mouth, lips, on the chin are radial scars, which are the result of congenital syphilis transferred in infancy or early childhood - Gochsinger's diffuse papular infiltration.

Damage to the nervous system observed frequently and is manifested by mental retardation, speech disorder, hemiplegia, hemiparesis, dorsal tabes, Jacksonian epilepsy (convulsive twitching of one half of the face or limb due to gumma or limited meningitis).

specific retinitis. The choroid, retina, optic nerve papilla are affected. On the fundus, a typical picture of small pigmented foci in the form of "salt and pepper" is revealed.

Dystrophies (stigmas) sometimes indicate congenital syphilis. May be a manifestation of syphilitic lesions of the endocrine, cardiovascular and nervous systems:
- high ("lancet" or "Gothic") hard palate;
- dystrophic changes in the bones of the skull: protruding frontal and parietal tubercles, but without a dividing groove;
- additional tubercle of Carabelli: an additional tubercle appears on the inner and lateral surface of the upper molars;
- absence of the xiphoid process of the sternum (axifoidia);
- infantile little finger (Dubois-Hissar symptom) or shortening of the little finger (Dubois symptom);
Widely spaced upper incisors (Gachet symptom).
- thickening of the sternoclavicular joint (symptom of Avsitidia);
Hypertrichia can be observed in both girls and boys. Often there is an overgrowth of the forehead with hair.

Diagnosis of congenital syphilis

It should be noted that only a few dystrophies (stigmas) can be of diagnostic value and only in combination with reliable signs of syphilis. In establishing the diagnosis, standard serological tests, which are defined as "positive" in early congenital syphilis, can be of invaluable help. In late congenital syphilis, complex serological reactions (CSR) are defined as "positive" in 92%, and immunofluorescence reactions (RIF), pale treponema immobilization reaction (RIBT) - in all patients. An important diagnostic value is the study of cerebrospinal fluid, radiography of the osteoarticular apparatus, consultation and examination by a pediatrician, ophthalmologist, otolaryngologist, neuropathologist and other specialists.

When conducting a differential diagnosis of early latent congenital syphilis and passive transmission of antibodies, quantitative reactions are of great importance. Antibody titers in a sick child should be higher than in the mother. In healthy children, antibody titers decrease and spontaneous negative serological reactions occur within 4-5 months. In the presence of infection, antibody titers are persistent or their increase is observed. In the first days of a child's life, serological tests may be negative despite the presence of syphilis, so they are not recommended in the first 10 days after the birth of a child.

If congenital syphilis is suspected, diagnostic tactics must be followed, which is as follows:
- conduct a one-time examination of the mother and child;
- it is not recommended to take blood for serological examination in a woman 10-15 days before and earlier than 10-15 days after childbirth;
- it is not advisable to take blood for serological examination from the umbilical cord of a child in the first 10 days after birth, since protein lability, instability of serum colloids, lack of complement and natural hemolysis, etc. are observed during this period;
- in the serological examination of the mother and child, it is necessary to use a complex of serological reactions (Wasserman reaction, RIF, RIBT);
- it should also be remembered that positive serological reactions in a child may be due to the passive transfer of antibodies from the mother, but gradually, within 4-6 months after birth, the antibodies disappear and the test results become negative.

Treatment of congenital syphilis

Pale treponema is actually the only microorganism that has retained to date, despite decades of penicillin therapy, a unique high sensitivity to penicillin and its derivatives. It does not produce penicillinases and does not have other mechanisms of antipenicillin protection (such as mutations in cell wall proteins or the polyvalent drug resistance gene) that have long been developed by other microorganisms. Therefore, even today the main method of modern antisyphilitic therapy is the long-term systematic administration of penicillin derivatives in sufficient doses.
And only if the patient is allergic to penicillin derivatives or if the strain of pale treponema isolated from the patient is confirmed to be resistant to penicillin derivatives, can an alternative treatment regimen be recommended - erythromycin (other macrolides are probably also active, but their effectiveness is not documented by the instructions of the Ministry of Health, and therefore they not recommended), or tetracycline derivatives, or cephalosporins. Aminoglycosides suppress the reproduction of pale treponema only in very high doses, which have a toxic effect on the host organism, therefore the use of aminoglycosides as monotherapy for syphilis is not recommended. Sulfonamides are generally not effective for syphilis.

In neurosyphilis, a combination of oral or intramuscular administration of antibacterial drugs with their endolumbar administration and with pyrotherapy, which increases the permeability of the blood-brain barrier for antibiotics, is mandatory.

With widespread tertiary syphilis against the background of pronounced resistance of pale treponema to antibacterial drugs and with a good general condition of the patient, allowing for a certain toxicity of the therapy, it may be recommended to add bismuth derivatives (biyoquinol) or arsenic derivatives (miarsenol, novarsenol) to antibiotics. Currently, these drugs are not available in the general pharmacy network and are only available in specialized institutions in limited quantities, as they are highly toxic and rarely used.

With syphilis, it is imperative to treat all the patient's sexual partners. In the case of patients with primary syphilis, all persons who have had sexual contact with the patient during the last 3 months are treated. In the case of secondary syphilis, all persons who had sexual contact with the patient during the last year.

Forecast disease is mainly determined by the rational treatment of the mother and the severity of the disease of the child. As a rule, early treatment, good nutrition, careful care, and breastfeeding contribute to favorable results. The timing of the start of treatment is of great importance, since specific therapy started after 6 months is less effective.
In recent years, in infants with congenital syphilis, due to a full course of treatment, standard serological reactions become negative by the end of the 1st year of life, with late congenital syphilis - much later, and RIF, RIBT can remain positive for a long time.

Prevention of congenital syphilis

The system of dispensary services for the population (mandatory registration of all patients with syphilis, identification and treatment of sources of infection, free high-quality treatment, preventive examinations of pregnant women, employees of childcare facilities, food enterprises, etc.) led to a sharp decrease in cases of registration of congenital forms of syphilitic infection by the end of the 80s . However, in the context of the epidemic increase in the incidence of syphilis, noted in the 90s, there was a sharp jump in the number of registered cases of congenital syphilis. Control over the situation is facilitated by the constant connection of women's and children's clinics and maternity hospitals with skin and venereal dispensaries. According to the instructions existing in our country, antenatal clinics register all pregnant women and subject them to clinical and serological examination. Serological examination for syphilis is carried out twice - in the first and second halves of pregnancy. If an active or latent form of syphilis is detected in a pregnant woman, treatment is prescribed only with antibiotics. If a woman has had syphilis in the past and has completed anti-syphilitic treatment, then during pregnancy, specific prophylactic treatment is still prescribed to ensure the birth of a healthy child. For 1-2 weeks. before delivery, non-specific false-positive serological reactions may occur. In this case, the pregnant woman is not subjected to specific treatment, and after 2 weeks. after childbirth, the examination of the mother is repeated and the child is carefully examined. When the diagnosis of syphilis is confirmed in the mother and child, they are prescribed anti-syphilitic treatment. Newborns, mothers who were insufficiently treated in the past and who for some reason could not receive preventive treatment during pregnancy, are examined to determine the form and localization of the syphilitic infection, then treatment is prescribed according to the schemes approved by the Ministry of Health of Ukraine. And newborns whose mothers had syphilis and received full treatment before and during pregnancy are subjected to a thorough examination, followed by follow-up observation up to 15 years. 07/31/2018

In St. Petersburg, the AIDS Center, in partnership with the City Center for the Treatment of Hemophilia and with the support of the Society of Hemophilia Patients of St. Petersburg, launched a pilot information and diagnostic project for patients with hemophilia infected with hepatitis C.

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