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Maternal and Congenital Syphilis in Brooklyn, NY: Epidemiology, Transmission, and Diagnosis

Maternal and Congenital Syphilis in Brooklyn, NY: Epidemiology, Transmission, and Diagnosis Abstract • Objective. —To define the epidemiology, to determine factors associated with transmission, and to describe the clinical and laboratory features of congenital syphilis. Design.—Retrospective chart review and prospective analysis. Setting. —Kings County Hospital Center, Brooklyn, NY. Patients. —A total of 403 pregnancies during a 23-month period associated with positive syphilis serological findings. Results. —Seventy-three pregnancies (18%) resulted in congenital syphilis (35 live-born and 40 stillborn neonates). Pregnancies associated with congenital syphilis were significantly associated with lack of prenatal care, lack of maternal therapy for syphilis, and a higher rapid plasma reagin titer, but not with a reported history of "crack" or cocaine use, although detection of cocaine in urine samples was more likely with positive syphilis serology. Conclusion. —Most live-born infants with congenital syphilis (23 of 35) lacked rash, hepatosplenomegaly, or adenopathy but were identified by laboratory tests (roentgenograms, cerebrospinal fluid VDRL test, conjugated bilirubin determination, or aspartate aminotransferase levels in serum samples). Half of the infants with congenital syphilis were stillborn.(AJDC. 1993;147:727-731) References 1. Centers for Disease Control. Syphilis and congenital syphilis—United States, 1985-1988 . MMWR Morb Mortal Wkly Rep . 1988;37:486-489. 2. Centers for Disease Control. Congenital syphilis—United States, 1983-1985 . JAMA . 1986;256:3206-3208.Crossref 3. Centers for Disease Control. Increases in primary and secondary syphilis—United States . MMWR Morb Mortal Wkly Rep . 1987;36:394-397. 4. Centers for Disease Control. Congenital syphilis—New York City, 1986-1988 . MMWR Morb Mortal Wkly Rep . 1989;38:825-829. 5. Zenker P. New case definition for congenital syphilis reporting . Sex Transm Dis . 1991;18:44-45.Crossref 6. Centers for Disease Control. Guidelines for the prevention and control of congenital syphilis . MMWR Morb Mortal Wkly Rep . 1988;37(S-1): 1-13. 7. Cohen DA, Boyd D, Prabhudas I, Mascola L. The effects of case definition in maternal screening and reporting criteria on rates of congenital syphilis . Am J Public Health . 1990;80:316-317.Crossref 8. Zenker PN, Berman SM. Congenital syphilis: reporting and reality . Am J Public Health . 1990;80:271-272.Crossref 9. Centers for Disease Control. Case definitions for public health surveillance . MMWR Morb Mortal Wkly Rep . 1990;39:34-38. 10. Musher DM. Syphilis . Infect Dis Clin North Am . 1987;1:83-95. 11. Minkoff HL, McCalla S, Delke I, Stevens R, Salwen M, Feldman J. The relationship of cocaine use to syphilis and human immunodeficiency virus infections among inner-city parturient women . Am J Obstet Gynecol . 1990; 163:521-526.Crossref 12. Tuffanelli DL, Wuepper KD, Bradford LL, Wood RM. Fluorescent treponemal-antibody absorption tests: studies of false-positive reaction to tests for syphilis . N Engl J Med . 1967;276:258-261.Crossref 13. Ricci JM, Fojaco RM, O'Sullivan MJ. Congenital syphilis: the University of Miami/Jackson Memorial Medical Center experience, 1986-1988 . Obstet Gynecol . 1989;74:687-693. 14. Mascola L, Pelosi R, Blount JH, Binkin NJ, Alexander CE, Cates W Jr. Congenital syphilis: why is it still occurring? JAMA . 1984;252:1719-1722.Crossref 15. Rawstron SA, Bromberg K. Failure of recommended maternal therapy to prevent congenital syphilis . Sex Transm Dis . 1991;18:102-106.Crossref 16. Mascola L, Pelosi R, Alexander CE. Inadequate treatment of syphilis in pregnancy . Am J Obstet Gynecol . 1984;150:945-947.Crossref 17. Hardy JB, Hardy PH, Oppenheimer EH, Ryan SJ Jr, Sheff RN. Failure of penicillin in a newborn with congenital syphilis . JAMA . 1970;212:1345-1349.Crossref 18. Wendel GD. Gestational and congenital syphilis . Clin Perinatol . 1988;15:287-303. 19. McKown RR, Kapernick PS. Syphilis in pregnancy . South Med J . 1988;81:447-451.Crossref 20. Srinivasan G, Ramamurthy RS, Bharathi A, Voora S, Pildes RS. Congenital syphilis: a diagnostic and therapeutic dilemma . Pediatr Infect Dis . 1983;2:436-441.Crossref 21. Fiumara NJ, Fleming WL, Downing JG, Good FL. The incidence of prenatal syphilis at the Boston City Hospital . N Engl J Med . 1952;247:48-52.Crossref 22. Ingraham NR. The value of penicillin alone in the prevention and treatment of congenital syphilis . Acta Derm Venereol Stockh . 1951;31( (suppl 24) ):60-88. 23. Ingraham NR. The diagnosis of infantile congenital syphilis during the period of doubt . Am J Syph Neurol . 1935;19:547-580. 24. Platou RV. Treatment of congenital syphilis with penicillin . Adv Pediatr . 1949;4:39-81. 25. Sanchez PJ, McCracken GH Jr, Wendel GD, Olsen K, Threlkeld N, Norgard MV. Molecular analysis of the fetal IgM response to Treponema pallidum antigens: implications for improved serodiagnosis of congenital syphilis . J Infect Dis . 1989;159:508-517.Crossref 26. Sarff LD, Platt LH, McCracken GHJ. Cerebrospinal fluid evaluation in neonates: comparison of high-risk infants with and without meningitis . J Pediatr . 1976;88:473-477.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

Maternal and Congenital Syphilis in Brooklyn, NY: Epidemiology, Transmission, and Diagnosis

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Publisher
American Medical Association
Copyright
Copyright © 1993 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1993.02160310029012
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Abstract

Abstract • Objective. —To define the epidemiology, to determine factors associated with transmission, and to describe the clinical and laboratory features of congenital syphilis. Design.—Retrospective chart review and prospective analysis. Setting. —Kings County Hospital Center, Brooklyn, NY. Patients. —A total of 403 pregnancies during a 23-month period associated with positive syphilis serological findings. Results. —Seventy-three pregnancies (18%) resulted in congenital syphilis (35 live-born and 40 stillborn neonates). Pregnancies associated with congenital syphilis were significantly associated with lack of prenatal care, lack of maternal therapy for syphilis, and a higher rapid plasma reagin titer, but not with a reported history of "crack" or cocaine use, although detection of cocaine in urine samples was more likely with positive syphilis serology. Conclusion. —Most live-born infants with congenital syphilis (23 of 35) lacked rash, hepatosplenomegaly, or adenopathy but were identified by laboratory tests (roentgenograms, cerebrospinal fluid VDRL test, conjugated bilirubin determination, or aspartate aminotransferase levels in serum samples). Half of the infants with congenital syphilis were stillborn.(AJDC. 1993;147:727-731) References 1. Centers for Disease Control. Syphilis and congenital syphilis—United States, 1985-1988 . MMWR Morb Mortal Wkly Rep . 1988;37:486-489. 2. Centers for Disease Control. Congenital syphilis—United States, 1983-1985 . JAMA . 1986;256:3206-3208.Crossref 3. Centers for Disease Control. Increases in primary and secondary syphilis—United States . MMWR Morb Mortal Wkly Rep . 1987;36:394-397. 4. Centers for Disease Control. Congenital syphilis—New York City, 1986-1988 . MMWR Morb Mortal Wkly Rep . 1989;38:825-829. 5. Zenker P. New case definition for congenital syphilis reporting . Sex Transm Dis . 1991;18:44-45.Crossref 6. Centers for Disease Control. Guidelines for the prevention and control of congenital syphilis . MMWR Morb Mortal Wkly Rep . 1988;37(S-1): 1-13. 7. Cohen DA, Boyd D, Prabhudas I, Mascola L. The effects of case definition in maternal screening and reporting criteria on rates of congenital syphilis . Am J Public Health . 1990;80:316-317.Crossref 8. Zenker PN, Berman SM. Congenital syphilis: reporting and reality . Am J Public Health . 1990;80:271-272.Crossref 9. Centers for Disease Control. Case definitions for public health surveillance . MMWR Morb Mortal Wkly Rep . 1990;39:34-38. 10. Musher DM. Syphilis . Infect Dis Clin North Am . 1987;1:83-95. 11. Minkoff HL, McCalla S, Delke I, Stevens R, Salwen M, Feldman J. The relationship of cocaine use to syphilis and human immunodeficiency virus infections among inner-city parturient women . Am J Obstet Gynecol . 1990; 163:521-526.Crossref 12. Tuffanelli DL, Wuepper KD, Bradford LL, Wood RM. Fluorescent treponemal-antibody absorption tests: studies of false-positive reaction to tests for syphilis . N Engl J Med . 1967;276:258-261.Crossref 13. Ricci JM, Fojaco RM, O'Sullivan MJ. Congenital syphilis: the University of Miami/Jackson Memorial Medical Center experience, 1986-1988 . Obstet Gynecol . 1989;74:687-693. 14. Mascola L, Pelosi R, Blount JH, Binkin NJ, Alexander CE, Cates W Jr. Congenital syphilis: why is it still occurring? JAMA . 1984;252:1719-1722.Crossref 15. Rawstron SA, Bromberg K. Failure of recommended maternal therapy to prevent congenital syphilis . Sex Transm Dis . 1991;18:102-106.Crossref 16. Mascola L, Pelosi R, Alexander CE. Inadequate treatment of syphilis in pregnancy . Am J Obstet Gynecol . 1984;150:945-947.Crossref 17. Hardy JB, Hardy PH, Oppenheimer EH, Ryan SJ Jr, Sheff RN. Failure of penicillin in a newborn with congenital syphilis . JAMA . 1970;212:1345-1349.Crossref 18. Wendel GD. Gestational and congenital syphilis . Clin Perinatol . 1988;15:287-303. 19. McKown RR, Kapernick PS. Syphilis in pregnancy . South Med J . 1988;81:447-451.Crossref 20. Srinivasan G, Ramamurthy RS, Bharathi A, Voora S, Pildes RS. Congenital syphilis: a diagnostic and therapeutic dilemma . Pediatr Infect Dis . 1983;2:436-441.Crossref 21. Fiumara NJ, Fleming WL, Downing JG, Good FL. The incidence of prenatal syphilis at the Boston City Hospital . N Engl J Med . 1952;247:48-52.Crossref 22. Ingraham NR. The value of penicillin alone in the prevention and treatment of congenital syphilis . Acta Derm Venereol Stockh . 1951;31( (suppl 24) ):60-88. 23. Ingraham NR. The diagnosis of infantile congenital syphilis during the period of doubt . Am J Syph Neurol . 1935;19:547-580. 24. Platou RV. Treatment of congenital syphilis with penicillin . Adv Pediatr . 1949;4:39-81. 25. Sanchez PJ, McCracken GH Jr, Wendel GD, Olsen K, Threlkeld N, Norgard MV. Molecular analysis of the fetal IgM response to Treponema pallidum antigens: implications for improved serodiagnosis of congenital syphilis . J Infect Dis . 1989;159:508-517.Crossref 26. Sarff LD, Platt LH, McCracken GHJ. Cerebrospinal fluid evaluation in neonates: comparison of high-risk infants with and without meningitis . J Pediatr . 1976;88:473-477.Crossref

Journal

American Journal of Diseases of Children – American Medical Association

Published: Jul 1, 1993

References

  • Syphilis and congenital syphilis—United States, 1985-1988
    Centers for Disease Control
  • Congenital syphilis—United States, 1983-1985
    Centers for Disease Control
  • Increases in primary and secondary syphilis—United States
    Centers for Disease Control
  • Congenital syphilis—New York City, 1986-1988
    Centers for Disease Control
  • New case definition for congenital syphilis reporting
    Zenker P
  • Guidelines for the prevention and control of congenital syphilis
    Centers for Disease Control
  • The effects of case definition in maternal screening and reporting criteria on rates of congenital syphilis
    Cohen DA, Boyd D, Prabhudas I, Mascola L
  • Congenital syphilis: reporting and reality
    Zenker PN, Berman SM
  • Case definitions for public health surveillance
    Centers for Disease Control
  • Syphilis
    Musher DM
  • The relationship of cocaine use to syphilis and human immunodeficiency virus infections among inner-city parturient women
    Minkoff HL, McCalla S, Delke I, Stevens R, Salwen M, Feldman J
  • Fluorescent treponemal-antibody absorption tests: studies of false-positive reaction to tests for syphilis
    Tuffanelli DL, Wuepper KD, Bradford LL, Wood RM
  • Congenital syphilis: the University of Miami/Jackson Memorial Medical Center experience, 1986-1988
    Ricci JM, Fojaco RM, O'Sullivan MJ
  • Congenital syphilis: why is it still occurring?
    Mascola L, Pelosi R, Blount JH, Binkin NJ, Alexander CE, Cates W Jr
  • Failure of recommended maternal therapy to prevent congenital syphilis
    Rawstron SA, Bromberg K
  • Inadequate treatment of syphilis in pregnancy
    Mascola L, Pelosi R, Alexander CE
  • Failure of penicillin in a newborn with congenital syphilis
    Hardy JB, Hardy PH, Oppenheimer EH, Ryan SJ Jr, Sheff RN
  • Gestational and congenital syphilis
    Wendel GD
  • Syphilis in pregnancy
    McKown RR, Kapernick PS
  • Congenital syphilis: a diagnostic and therapeutic dilemma
    Srinivasan G, Ramamurthy RS, Bharathi A, Voora S, Pildes RS
  • The incidence of prenatal syphilis at the Boston City Hospital
    Fiumara NJ, Fleming WL, Downing JG, Good FL
  • The value of penicillin alone in the prevention and treatment of congenital syphilis
    Ingraham NR
  • The diagnosis of infantile congenital syphilis during the period of doubt
    Ingraham NR
  • Treatment of congenital syphilis with penicillin
    Platou RV
  • Molecular analysis of the fetal IgM response to Treponema pallidum antigens: implications for improved serodiagnosis of congenital syphilis
    Sanchez PJ, McCracken GH Jr, Wendel GD, Olsen K, Threlkeld N, Norgard MV
  • Cerebrospinal fluid evaluation in neonates: comparison of high-risk infants with and without meningitis
    Sarff LD, Platt LH, McCracken GHJ