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CONGENITAL SYPHILIS. TREATMENT AND PREVENTION OF SYPHILIS

The fact of transmission of syphilis to offspring was established in the late 15th - early 16th centuries. For several centuries, the question of the mechanism of transmission of syphilitic infection remained unclear.

For centuries, the germinative hypothesis was dominant, according to which syphilis is transmitted to the fetus only by the father through a sperm that directly infects the egg cell. According to this point of view, a child with syphilis could be born to a healthy mother in the presence of syphilis in the father (during this period, the causative agent of syphilis was not known, there was no serological diagnosis).

A great contribution to the justification of the existing maternal placental transmission of syphilis to offspring was made by the Vienna scientist R. Matzenauer in 1903 on the basis of long-term clinical observations.

Finally, placental theory gained universal acceptance after the discovery of Tr. pallidum (March 3, 1905) and the introduction of serological research methods for syphilis (1906).

Thus, congenital syphilis is an infectious disease, the infection of which occurs in utero from a sick mother, and the manifestations of the disease can occur both in the fetus and in infants and young children, in adolescence and adulthood. The likelihood of congenital syphilis depends on the stage of syphilis in the mother and the duration of her illness. The most dangerous for the fetus is the secondary period of syphilis in the mother and the first 3 years after infection, then, due to the development of infectious immunity in the mother, this ability decreases significantly and with each subsequent pregnancy the probability of having a healthy baby increases (Kassovich law).

Syphilis can be transmitted from a mother suffering from congenital syphilis, i.e., transmission to the second and even third generation. At the same time, according to B.M. Pashkova (1955), 10-15% of children from sick mothers are born healthy.

Ways of penetration of pale treponema into the fetus:

1) in the form of an embolus through the umbilical vein;

2) through the lymphatic cracks of the umbilical vessels;

3) with the mother’s blood flow through the placenta damaged by toxins of pale treponem (a healthy placenta is not permeable to Tr.
pallidum).

The defeat of the fetus occurs at 4-5 months of pregnancy, when the placental circulation begins to function.

Pregnancy outcomes without treatment:

- late miscarriages;

- stillbirth with a macerated fetus at 6-7 months of pregnancy;

- premature birth;

- The birth of a child with a clinic of early congenital syphilis;

- the birth of a healthy looking child.

Placental changes:

1) hypertrophied;

2) its mass is 1 / 3-1 / 4 of the mass of the fetus (normal - 1 / 5-1 / 6);

3) the germinal part: - edematous;

- with reduced tissue resistance;

- with the presence of peri- and endoarteritis, abscesses of villi and blood vessels.

4) Tr. pallidum is rarely detected in placental tissue.

Classification of Congenital Lues

Depending on the clinical signs, the timing of their appearance, the characteristics of the course of the disease, congenital syphilis is divided into:

1. Syphilis of the fetus.

2. Early congenital syphilis (up to 4 years of age):

a) infancy (up to 1 year);

b) early childhood (from 1 year to 4 years).

3. Late congenital syphilis (in children older than 4 years).

4. Latent congenital syphilis.

According to the International Classification of Diseases (ICD), congenital syphilis is divided into:

1. Early congenital syphilis manifest (with symptoms) and latent (up to 2 years);

Late congenital syphilis is manifest (with symptoms) and hidden at the age of a child from 2 years or more.
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CONGENITAL SYPHILIS. TREATMENT AND PREVENTION OF SYPHILIS

  1. Diagnosis and prevention of congenital syphilis
    The diagnosis of congenital syphilis is established on the basis of: 1) the detection in a child of active manifestations of syphilis and positive serological reactions; 2) the mother has expressed manifestations of syphilis, or latent, asymptomatic syphilis, detected on the basis of positive results of repeated serological testing; 3) anamnestic evidence
  2. Prevention of congenital syphilis
    Treatment of pregnant women is carried out in accordance with the diagnosis, make at least 2 injections of one of the benzathine penicillin preparations. The profile to lay down is carried out by 2-3 injections of an antibiotic of 2,400,000 units with an interval of 1 week. The prof-ka is provided with a 3-fold serologic survey of ber-x: in the 1st half of ber-ti (when appearing to an obstetrician-gynecologist. For registration by ber-ti) and in its second half (on
  3. Congenital syphilis. Fetal syphilis
    Under the influence of treponem, changes that occur in the placenta make it functionally inferior, as a result of which its intrauterine death occurs at the 6-7th month of pregnancy. The dead fruit is pushed out on the 3-4th day, usually in a macerated state. The macerated fruit, compared with a normally developing fruit of the same age, has significantly smaller sizes and weights. Leather
  4. Treatment and prevention of syphilis in children
    Early congenital manifest syphilis is diagnosed on the basis of positive serological reactions (CSF, RIFabs, RIT, ELISA), the presence of skin manifestations, bone changes (osteochondritis, periostitis), initial changes in the mucous membrane of the eye (chorioretinitis), phenomena of specific rhinitis, enlarged liver and spleen, pathology of cerebrospinal fluid. Of the listed symptoms may not be detected
  5. Treatment and prevention of syphilis
    The basic principles of treatment L. KSK after treatment. Criteria for cure and deregistration for people who have completed syphilis treatment. In the last century, only mercury and iodine preparations were used to treat L. patients. Introduction to the arsenal of antisyphilitic drugs arsenic drug - salvarsan (1909). Neosalvarsan (1912), and then bismuth (1920), was a new era in the treatment of syphilis.
  6. Tertiary syphilis. Congenital syphilis.
    Tertiary syphilis. Congenital
  7. Congenital syphilis
    Congenital syphilis (syphilis congenita) occurs due to infection of the fetus during pregnancy. In newborns, the development of acquired syphilis is also possible, which appears when a child is infected during childbirth. The source of infection of the fetus is only a mother with syphilis. The frequency of infection of children and the severity of congenital syphilis depend on the duration and
  8. Late Congenital Syphilis
    Late congenital syphilis (syphilis congenita tarda) occurs in patients who previously had signs of early congenital syphilis, or in children in whom congenital syphilis had not manifested before. The first symptoms of late congenital syphilis may appear 2 years after birth, but they usually do not develop after 30 years. S. T. Pavlov (1960) believes that most often late
  9. Congenital syphilis
    C. BREAST AGE. Syphilis transmission to offspring occurs mainly in the first 3 years after infection of the mother. In the future, this ability weakens, but does not completely disappear (the "Kassovich law"). Treponema pallidum infects the fetus already at the 8th week of pregnancy, penetrating the placenta, the chlamydial, cytomegalovirus,
  10. Late Congenital Syphilis
    Late congenital syphilis is considered by many authors as a relapse of syphilis, transferred in infancy or early childhood. Manifestations of late congenital syphilis are detected no earlier than 4-5 years of age, often at 14-15 years, and sometimes later. Lesions of the skin and mucous membranes in the form of tubercle and gummy syphilis do not differ from similar rashes with acquired
  11. Congenital syphilis.
    Even during the first epidemic of syphilitic infection, it was noted that in addition to adults, children suffer from syphilis, and that the manifestations of syphilis in children are different from the manifestations of syphilis in adults. In Russia, syphilis was the scourge of the royal villages. These patients were not treated, they gave birth to sick children, who in turn had sick children. More than 400 years ago
  12. Treatment of patients with syphilis. Cure criterion. Clinical examination of patients with syphilis
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  13. Early congenital syphilis
    Typical changes in early congenital syphilis (syphilis congenita praecox) are detected no earlier than the 5th month of pregnancy. Syphilis of the fetus ends in its death at the 6-7th month of pregnancy. A dead fetus is born on the 3-4th day, in 80% of cases in a macerated state. The placenta afflicted with syphilis is larger, hypertrophied, flabby, fragile, easily torn,
  14. Congenital syphilis in infants
    Preterm birth in mothers not treated for syphilis occurs in 30% of cases, in those who received treatment in 16% of cases. Congenital syphilis in infants is characterized by damage to many organs and systems, so its symptoms are extremely diverse. The earlier the signs of the disease appear, the more unfavorable the prognosis and the higher the mortality rate. For most children
  15. Congenital syphilis
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  16. Early childhood congenital syphilis
    It is characterized by mild clinical symptoms. The clinical picture corresponds to the secondary acquired period of syphilis or a latent course may be observed. The clinic is dominated by large papules and broad warts, so some authors call this period condylomatous. The main features of the clinical picture of syphilis in early childhood 1)
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