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Pregnant women with syphilis and true penicillin allergy should be admitted for desensitization and treatment Women in late pregnancy treated for early syphilis should have close outpatient monitoring or be admitted because the Jarisch-Herxheimer reaction can induce premature labor
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Goh BT Syphilis in adults Sex Transm Infect 2005 Dec;81(6): 448 52 [PMID: 16326843] Hall CS et al Managing syphilis in the HIV-infected patient Curr Infect Dis Rep 2004 Feb;6(1):72 81 [PMID: 14733852] Marra CM et al Normalization of cerebrospinal fluid abnormalities after neurosyphilis treatment: does HIV status matter Clin Infect Dis 2004 Feb 1;189(3):369 76 [PMID: 14745693] O donnell JA et al Neurosyphilis: A current review Curr Infect Dis Rep 2005 Jul;7(4):277 284 [PMID: 15963329] Sexually transmitted diseases treatment guidelines 2006 MMWR Recomm Rep 2006 Aug 4;55(RR-11):1 94 [PMID: 16888612]
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NON SEXUALLY TRANSMITTED TREPONEMATOSES
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A variety of treponemal diseases other than syphilis occur endemically in many tropical areas of the world They are distinguished from disease caused by T pallidum by their nonsexual transmission, their relatively high incidence in certain geographic areas and among children, and their tendency to produce less severe visceral manifestations As in syphilis, organisms can be demonstrated in infectious lesions with darkfield microscopy or immunofluorescence but cannot be cultured in artificial media; the serologic tests for syphilis are positive, including the newer tests such as CAPTIA Syph G; the diseases have primary, secondary, and sometimes tertiary stages; and penicillin is the drug of choice There is evidence that infection with these agents may provide partial resistance to syphilis and vice versa Treatment with penicillin in doses appropriate to primary syphilis (eg, 24 million units of benzathine penicillin G intramuscularly) is generally curative in any stage of the non sexually transmitted treponematoses In cases of penicillin hypersensitivity, tetracycline, 500 mg orally four times a day for 10 14 days, is usually the recommended alternative
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8 Congenital Syphilis
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Congenital syphilis is a transplacentally transmitted infection that occurs in infants of untreated or inadequately treated mothers The physical findings at birth are quite variable: The infant may have many or minimal signs or even no signs until 6 8 weeks of life (delayed form) The most common findings are on the mucous membranes and skin maculopapular rash, condylomas, mucous membrane patches, and serous nasal discharge (snuffles) These lesions are infectious; T pallidum can easily be found microscopically, and the infant must be isolated Other common findings are hepatosplenomegaly, anemia, or osteochondritis These early active lesions subsequently heal, and if the disease is left untreated it produces the characteristic stigmas of syphilis interstitial keratitis, Hutchinson s teeth, saddle nose, saber shins, deafness, and central nervous system involvement The presence of negative serologic tests at birth in both the mother and the infant usually means that the newborn is free of infection However, recent infection near the time of delivery may result in negative tests because there has been insufficient time to develop a serologic response Thus, it is necessary to maintain a high index of suspicion in infants with delayed onset of symptoms despite negative serologic tests at birth, especially in infants born to high-risk mothers (HIVpositive, illicit drug users) All infants born to mothers with positive nontreponemal and treponemal antibody titers should have blood drawn for an RPR or VDRL test and, if positive, be referred to a pediatrician for further evaluation and therapy
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Yaws is a contagious disease largely limited to tropical regions that is caused by T pallidum subsp pertenue It is characterized by granulomatous lesions of the skin, mucous membranes, and bone Yaws is rarely fatal, though if untreated it may lead to chronic disability and disfigurement Yaws is acquired by direct nonsexual contact, usually in childhood, although it may occur at any age The mother yaw, a painless papule that later ulcerates, appears 3 4 weeks after exposure There is
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