Sunday, June 04, 2006

Syphilis

Syphilis is a weird disease. I practically never see anyone sick from it, at least not visibly sick, but yet often treat babies with it for many days in the hospital. That's because syphilis nowadays, especially in babies, is almost always diagnosed or suspected not by signs of illness but rather by an abnormal laboratory test.

Every mother is supposed to have a blood test for syphilis at or shortly before the time of delivery. The test detects the presence of antibodies to syphilis and the result is expressed as a a titer, e.g. 1:1, 1:2, 1:4, and so on. The higher the titer, the easier it is to detect the antibodies. A problem is that after someone has syphilis, the test for it can remain positive for years, making it difficult to know for sure whether a positive test is due to new infection or to old, previously treated infection. Sometimes by history we can sort it out, but other times we simply cannot. Since untreated syphilis can be transmitted to the baby in utero and lead to bad problems such as insanity or death, we err on the side of treatment if there is uncertainty of the diagnosis.

We currently are treating a baby for possible syphilis whose mother had syphilis in 1997 that was, as far as we can tell, treated adequately. Her syphilis titer in this pregnancy went from 1:2 originally to 1:4 and then 1:8 at the end of the pregnancy. Is this just some variation in the lab test, or new infection in the mother? The baby's titer is also 1:8. Is that just transferred old antibody from the mother, or is it real infection in the baby? We aren't sure, but the chances of new infection in the mother - and passing it on to the baby - are great enough that we did a spinal tap on the baby to rule out nervous system syphilis and are treating the baby with ten days of penicillin.

It can be a little tricky sometimes talking to parents about syphilis. Mom's usually embarassed, and you have to try to make them understand the antibody thing, then convince them to let you do a spinal tap on their seemingly healthy baby and keep the baby in the hospital for ten days of treatment. But I bet it's trickier for the mother to discuss it with her partner and other relatives. She almost has to either accuse her partner or herself of infidelity - no small thing - or else claim it's just laboratory variation in the antibody testing, which is pretty hard for one layperson to explain to another.

For crying our loud, don't sleep around, and if you do, use protection. Your baby might thank you for it someday.

13 Comments:

Blogger Flea said...

Embarrassing consent-talks aside, the risk-benefit of treating babies with suspected syph makes this one a no-brainer, doesn't it?

Flea

7:38 PM  
Anonymous Anonymous said...

Re: "For crying our loud, don't sleep around, and if you do, use protection. Your baby might thank you for it someday."

Uhhh... you do know that many women are infected with STDs from a supposedly monogamous relationship that they discover wasn't as monogamous as they thought?

2:26 PM  
Anonymous Anonymous said...

Did you test the father of this baby for syphilis? Do you ever test a father in this situation? Mom didn't aquire this infection all on her own.

Do you ever tell the fathers of these babies "Don't sleep around!"

5:04 PM  
Blogger neonataldoc said...

Flea, you are absolutely correct.

Anonymous #1, You are correct, too, of course, but the odds of getting syphilis go up if you're not in a monogamous relationship. You're right, there are no guarantees.

Anonymous #2, I would certainly tell the fathers "Don't sleep around." Birth control and protection are the responsibility of both parties. Since I only take care of babies, I do not test the fathers. But I contacted the obstetrician of this mother, who arranged for treatment for the mother, and the center that treats her should have mother notify the father. If the mother wants us to, I would talk to the father. It's tough, with all the confidentiality rules, but any partner of the mother should be tested.

9:29 PM  
Blogger Judy said...

We've been seeing an upsurge in syphilis - or at least suspected syphilis in our NICU lately too. Seemed for a while like it was pretty much gone, but it's back.

The hardest cases are those with relatively low titers and minimal or no prenatal care. Treatment of the baby is pretty much a given, because you only have the one maternal titer to base the decision on. Mom may have been treated prior to pregnancy, but didn't go back and get re-tested.

At least we haven't seen any with positive spinal fluid or evidence of infection on the long-bone xrays.

1:16 AM  
Anonymous Anonymous said...

does Lymes disease ever cause a positive on a syphilis test?
if so would you treat it the same way?

1:40 AM  
Blogger neonataldoc said...

Anonymous: There are two tests for syphilis, one non-specific and one specific. I'm not sure, maybe the non-specific test could be made positive by lyme's disease, but not the specific one. Does that help or just confuse you more?

10:02 PM  
Anonymous Anonymous said...

Does the high rpr in the father ever affect the unborn child?

1:13 PM  
Anonymous Anonymous said...

I have a mom with + RPR 1:4 and a baby with RPR 1:2,what would you do? I am waiting for treponemal test FTA ABS. Mother was treated both for HSV and for syphilis a year prior to delivery.

2:06 AM  
Anonymous Anonymous said...

Easy now, I am a father never slept around, my new born was born with congenital syph, in the past 2 years, i have had all kinds of medicals ( govt tests which as many of u know , include STDs, none of which came out positive)( including one just 8 weeks ago). My wife kept silent about it, until I got to hospital and read the medical records, being who I am , I have not exploded over it yet. I am dazed, angry and confused. Am almost certain, if she accuses me of it, if I raise this issue, I will divorce her

1:55 PM  
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Anonymous Anonymous said...

What's the update on the baby?

10:05 PM  

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