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Syphilis Pregnancy 35 y.o. G4P3 presents at 30 weeks for her prenatal visit. The FOB of...

Syphilis Pregnancy

35 y.o. G4P3 presents at 30 weeks for her prenatal visit. The FOB of this baby is the same FOB as her last child, born 10 months ago. During that pregnancy, she was negative for all STI. Her 29 week labs were normal with the exception of a positive RPR with a titer of 1:2400. She then had a positive T. Palladium. She has had no new partners. FOB was last tested 8 months ago and was negative.

Allergies: Penicillin – was told she had hives as a child

Medications: Prenatal vitamins and iron

PMH: Migraines

PSH: None

OB History:

5 years ago NSVD, no complications in pregnancy or delivery

3 years ago NSVD, no complications in pregnancy or delivery

10 months ago NSVD, no complications in pregnancy or delivery

Current pregnancy history: Normal pregnancy course

Social history: Does not drink alcohol, does not smoke cigarettes, smokes marijuana daily, no other drug use.

1. Subjective: Write out the subjective information. Write what other information you would want.

2. Objective: Write out an objective assessment that you would expect to find. Include only the relevant systems.

3. Plan: Based on the information provided, what would your plan for treatment be?

4. How would you interpret her labs in terms of RPR Reactive, Titer 1:2400? Please explain how the titers are run.

5. There are two ways to test for syphilis in pregnancy. The first is what we see in this case and the second is what is known as the “reverse algorithm”. Please describe the two ways and the advantages/disadvantages to each.

6. What is your education on the risks to baby?

Solutions

Expert Solution

Subjective Data of Syphilis in Pregnancy:

-Manifestation of syphilis in pregnancy are the same as for ono-pregnant women and syphilis may be acquired at any stage of pregnancy whenever a pregnant women is exposed.

- If a pregnant women is infected the T.Pallidum organisim that enters her blood stream can be transmitted to the fetus.

- Transmission of T.Pallidum to the fetus usually occurs between 16- 28 weeks of pregnancy(but can happen as early as 9 weeks).

- The likelihood of transmission is directly related to the stage of syphillis in the infected pregnant women.The concentration of spirochaetes in blood is highest in the primary and secondary stages of disease and decreases slowly thereafter(because of acquired immunity).

- The course of meternal infection does not seem to be altered by pregnancy.

- The risk associated with syphilis in pregnancy can result in early fetal death,low birth weight ,preterm delivery,neonatal death,infection or disease in newborn.

Objective Data:

The diagnosis of syphilis has beenmostly on the second trimester of gestation followed by the third trimester.Nationwide statistics shows that syphilis is mostly detected in the third trimester of gestation, reflecting the fact that the access to prenatal screening and tests often comes later,showing late prenatal screening and a lack of access to testing.There is a tendency towards inadequate treatment as the time window between infection and treatment is larger and there is a therapeutic need to halt treatment 4 weeks prior to birth.

Treatment Plan:

When there is penicillin allergy which is considered the most effective mode of treatment as an alternative therapeutic option since Doxycycline and tetracycline cannot be used during pregnancy.Endovenous ceftraxone as a second line treatment in pregnant womentreats on congenital infections.

RPR Titer Interpretation:

Syphilis antibodies should be lower following treatment.For example,if the RPR was initially reported as 1:256 a value of 1:16 after treatment would indicate a lower level of antibody.If the titer remains the same or rises,the affected person may have a persistent infection or was reinfected.

A positive titer with a VDRL or RPR indicates active syphilis and follo up serologic testing is performed to monitor treatment response.

Reverse Algorithm:

A reverse sequence syphilis screening alogrithm is widely used for syphilis testing. Screening for syphilis is performed using either a nontreponemal or treponemal test.Both syphilis alogorithms are used by laboratories.

Risk Factors:

Syphilis in pregnant women can cause miscarriage ,stillbirth or the baby’s death shortly after birth.Approximately 40% of babies born to women with untreated syphilis can be stillborn or die from the infection as a newborn.

Nightingale answered 1 year ago

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