Syphilis in Pregnancy and Congenital Syphilis: Reality in a Portuguese Central University Hospital

Abstract

Purpose To evaluate maternal-fetal surveillance and follow-up of infants at risk for congenital syphilis (CS).

Methods Retrospective cohort study in a Portuguese Tertiary Referral Hospital. The main inclusion criterion was a positive syphilis serology. The study included all pregnant women that delivered in our hospital between January 2004 and December 2013. The neonates were classified according to their probability of infection based on the Centers for Disease Control and Prevention guidelines.

Results Among the 27 pregnancies at risk for CS, 48.2% (n = 13) of the women had a diagnosis during the 1st trimester, and the median gestational age at the end of the treatment was 28 weeks. Inadequate treatment was noted in 44.4% (n = 12) of the women. Adverse pregnancy outcomes were observed in 30.8% of the cases (n = 8), 5 of which had been adequately treated. We found 2 (7.7%) cases with “proven or highly probable CS,” 10 (38.5%) with “possible CS,” 12 (46.1%) with “less likely CS,” and 2 (7.7%) with “unlikely CS.” Among the infants, the treatment was successful, except for 1 neurosyphilis case.

Conclusion This study highlights many of the difficulties/concerns encountered in the maternal-neonatal management of syphilis. We highlight the importance of assuring the early detection of the infection as a way of guaranteeing the timely treatment, as well as a good compliance to the treatment and follow-up through a more efficient pregnant women surveillance network.

Resumo

Objetivo Avaliar a vigilância materno-fetal e o acompanhamento de crianças em risco de sífilis congênita (SC).

Métodos Estudo de coorte retrospetivo desenvolvido num hospital terciário de referência, cujo principal critério de inclusão foi a presença de serologia positiva para sífilis. O estudo incluiu todas as grávidas admitidas no nosso Hospital entre janeiro de 2004 e dezembro de 2013. Os recém-nascidos foram classificados de acordo com a probabilidade de infeção, com base nas recomendações do Centers for Disease Control and Prevention.

Resultados Entre as 27 gravidezes em risco de SC, 48,2% (n = 13) tiveram diagnóstico durante o 1° trimestre; a idade gestacional média no final do tratamento foi de 28 semanas. Em 44,4% (n = 12) das mulheres, o tratamento foi considerado inadequado. Em 30,8% dos casos (n = 8) houve algum evento adverso da gravidez, dos quais 5 foram adequadamente tratados. Em dois dos casos (7,7%) a SC foi provada ou considerada como altamente provável, 10 (38,5%) com SC provável, 12 (46,1%) com SC pouco provável, e 2 (7,7%) com SC improvável. Nos lactentes, o tratamento foi bem sucedido, com exceção de um caso de neurossífilis.

Conclusão Este estudo visa realçar muitas das dificuldades/preocupações encontradas na vigilância materno-neonatal dos casos com diagnóstico de sífilis. ublinhamos, não só, a importância de se assegurar a deteção precoce de infeção como forma de se garantir o tratamento atempado, mas também, uma adequada adesão à vigilância/tratamento, através de uma rede mais eficiente entre as diferentes instituições envolvidas no acompanhamento das grávidas.

Keywords

syphilis - infection - congenital syphilis - prenatal diagnosis

Palavras-chave

sífilis - infecção - sífilis congênita - diagnóstico pré-natal

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