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Congenital Syphilis

Congenital Syphilis. Congenital Case #1. Mom: 21yrs, Am. Ind., Non- Hisp No regular prenatal care 1 st visit 11-15-13 Last visit 1-29-14 4-14-14 presents at small hospital for L& D Dr. notices labial sore, and questions patient

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Congenital Syphilis

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  1. Congenital Syphilis

  2. Congenital Case #1 • Mom: 21yrs, Am. Ind., Non-Hisp • No regular prenatal care • 1st visit 11-15-13 • Last visit 1-29-14 • 4-14-14 presents at small hospital for L& D • Dr. notices labial sore, and questions patient • Patient states that the sore “had been there a while” and it wasn’t too painful. • Labs Ordered and Results: • 11-15-13 – RPR was non reactive • 11-15-13 – Gonorrhea+ • 11-15-13 – Chlamydia and HIV – • 4-14-14 – RPR 1:64, TPPA reactive • 4-14-14 – CT/GC negative • Treatment: • 11-15-13 250mg Rocephin, 1gm Zith • 4-15-14 2.4 mUBicillin

  3. Born 4-14-14 • Healthy weight and length • No congenital deformities • No chancres, rash, or mucosal S/S • 4-15-14 unresolved fever • Baby was transferred to NICU at a larger hospital • Labs Ordered and Results: • 4-15-14 Lumbar puncture – WBC, CBC, protein, glucose all within normal limits. RPR and TPPA non reactive. • 4-15-14 Blood draw (non-umbilical) RPR 1:8 TPPA reactive • 4-15-14 Long Bone Survey – Normal • Treatment: • 4-16-14 IV Penicillin 150,000 units/kg/day for 10 days

  4. Congenital Case #2 • Mom: 16yrs, Am. Ind., Non-Hisp • No early prenatal care • Regular 3rd trimester care • No vaginal exams • 5-28-14 presents for 38 week visit. • Labs Ordered and Results: • 8-8-13 Chlamydia +, GC – • 11-20-13 RPR Non-reactive • 11-20-13 Gonorrhea + • 11-20-13 Chlamydia and HIV – • 5-28-14 RPR 1:256, TPPA reactive • Treatment: • 8-15-13 1gm Zith • 11-20-13 250 mg Rocephin and 1 gm Zith • 6-4-14 2.4 mUBicillin • Dr. refers mom for C-section and NICU for baby. • Vaginal exam 6-6-14, prior to C-section, healing lesion seen.

  5. Born 6-5-14 • Healthy weight and length • No congenital deformities • No chancres, rash, or mucosal S/S • Labs Ordered and Results: • 6-6-14 Lumbar puncture – WBC, CBC, protein, glucose all within normal limits. RPR and TPPA non reactive. • 6-6-14 Blood draw (non-umbilical) RPR 1:8 TPPA reactive • 6-6-14 Long Bone Survey - Normal • Treatment: • 6-6-14 IV Penicillin 150,000 units/kg/day for 10 days

  6. Congenital Case #3 • Mom: 25yrs, White, Non-Hisp • Regular prenatal appointments • No current S/S • No recollection of past S/S • 3-12-14 presents for 24 week care • Labs Ordered and Results: • 3-12-14 RPR 1:64, no TPPA done • 3-25-14 RPR 1:128, TPPA reactive • 5-12-14 RPR 1:64, TPPA reactive • 8-4-14 RPR 1:64, TPPA reactive • Additional labs pending • Treatment: • 3-24-14 2.4 mUBicillin • 4-7-14 2.4 mUBicillin • 5-21-14 2.4 mUBicillin • Concerns: • Re-infection • Treatment failure

  7. Born 6-5-14 via C-section • Healthy weight and length • No congenital deformities • No chancres, rash, or mucosal S/S • Labs Ordered and Results: • 7-22-14 Blood draw (non-umbilical) RPR 1:16, TPPA reactive • 7-23-14 Lumbar puncture -- WBC, CBC, protein, glucose all within normal limits. RPR and TPPA non reactive. • 7-23-14 Long Bone Survey – consistent with Congenital Syphilis • Treatment: • 7-23-14 IV Penicillin 200,000 units/kg/day for 10 days

  8. (Suspect) Congenital Case #4 • Mom: 22yrs, Am. Ind., Non-Hisp • 7-28-14, 1st prenatal appointment at 12 weeks • “Kissing” lesions & alopecia • Labs Ordered & Results: • 7-28-14 RPR 1:128, TPPA Reactive • 7-28-14 CT +, GC +, HIV - • Treatment: • 8-1-14 250mg Rocephin, 1gm Zith, 2.4 mUBicillin • Fetus: • No heartbeat detected on 8-11-14

  9. Is this the end of our Congenital Cases? Amanda Gill M.S. South Dakota Dept. of Health STD Program Manager amanda.gill@state.sd.us 605-773-4794 605-280-4793

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