Congenital Syphilis

Congenital syphilis results from transplacental transmission of spirochetes. Women with primary and
secondary syphilis and spirochetemia are more likely to transmit infection to the fetus than are women with
latent infection. Transmission can occur at any stage of pregnancy. The incidence of congenital infection in
the offspring of untreated infected women remains highest during the first 4 year after acquisition of primary
infection, secondary, and early latent disease.
The risk factors most commonly associated with congenital syphilis are lack of prenatal care and cocaine
drug abuse, which is associated with prostitution, unprotected sexual contact, and trading of sex for drugs, in
addition to inadequate prenatal care and poor treatment of syphilis during pregnancy

Clinical Manifestation
Among survivors, manifestations have traditionally been
divided into early and late stages. The early signs appear
during the first 2 yr of life, and late signs appear gradually
after the first 2 decades.

Diagnosis
Asymptomatic infants considered at risk for congenital syphilis because the maternal nontreponemal and
treponemal serology is positive should be evaluated if:
1. Maternal treatment was inadequate, unknown, or undocumented
2. Maternal treatment was 530 days before delivery
3. The mother was treated with erythromycin or another nonpenicillin regimen
4. The maternal nontreponemal titers did not decrease sufficiently to demonstrate a cure (4-fold or
greater)
If the maternal treatment was adequate and 21 mo before delivery, the infant's positive nontreponemal test
result represents passively acquired antibody and the infant does not need treatment at delivery, but followup serology should be obtained. If the maternal evaluation is incomplete, these infants are assumed infected
and treated

Treatment
Adequate maternal therapy should eliminate the risk for congenital syphilis. All infants born to mothers with
syphilis should be followed up until nontreponemal serology is negative. The infant should be treated if there
is any uncertainty about the adequacy of the mother's treatment.
Congenital syphilis is treated with aqueous penicillin G (100,000-150,000 U/kg/24 hr divided every 12 hr IV
for the 1st
week of life, and every 8 hr thereafter) or procaine penicillin G (50,000 Ulkg IM once daily) given for 10 days.
Higher concentrations
of penicillin are achieved in the CSF of infants treated with intravenous aqueous penicillin G than in those
treated with intramuscular procaine penicillin. Both penicillin regimens are still recognized as adequate
therapy for congenital syphilis.
Treated infants should be followed up serologically to confirm decreasing nontreponemal antibody titers. In a
very low risk neonate who is asymptomatic and whose mother was treated appropriately, without evidence
of relapse or reinfection, but with
a low and stable VDRL titer, no evaluation is necessary. Some specialists would treat such an infant with a
single dose of benzathine
penicillin G 50,000 units/kg IM.

Prevention
Routine prenatal screening for syphilis remains the most important factor in the identification of infants at
risk for development of congenital syphilis and is legally required at the beginning of prenatal care in all
states.
In pregnant women without optimal prenatal care, serologic screening for syphilis should be performed at the
time pregnancy is diagnosed. Any woman who is delivered of a stillborn infant 220 wk of gestation should be
tested for syphilis. In communities and
populations with a high prevalence of syphilis, or for patients at high risk, testing should be performed at
least 2 additional times:
at the beginning of the 3rd trimester (28 wk) and at delivery

Antibiotic classification
1. Aminoglycosides: Amikacin, Gentamicin, Kanamycin
MoA: Binding to bacterial 30s ribosomal subunit leaving the bacterium unable to synthesize proteins vital
to its growth
2. Ansamycins: Streptomycin
3. Carbacephem: Koracarbef
MoA: prevents bacterial cell division by inhibiting cell wall synthesis
4. Carbapenems: Doripenem Meropenem
MoA: Inhibition of cell wall synthesis
5. Cephalosporins (1st generation): Cefadroxil, Cefalotin
MoA: Disrupt synthesis of the peptidoglycan layer of bacterial cell walls
6. Cephalosporins (2nd generation): Cefaclor, Cefprozil
MoA: idem
7. Cephalosporins (3rd generation): Cefixime, Ceftriaxone
MoA: idem
8. Cephalosporins (4th generation): Cefepime
MoA: idem
9. Cephalosporins (5th generation): Ceftaroline fosamil, Ceftobiprole
MoA: idem
10. Glycopeptides: Vancomycin
MoA: Inhibiting peptidoglycan synthesis
11. Lincosamides: Clindamycin, Lincomycin
MoA: Bind to 50S subunit of bacterial ribosomal RNA thereby inhibiting protein synthesis
12. Lipopeptide: Daptomycin
MoA: Bind to the membrane and cause rapid depolarization, resulting in a loss of membrane potential
leading to inhibition of protein, DNA and RNA synthesis
13. Macrolides: Azithromycin, Erythromycin, Clarithromycin
MoA: Inhibition of bacterial protein biosynthesis by binding reversibly to the subunit 50S of bacterial
ribosome, thereby inhibiting translocation of Peptidyl-tRNA
14. Monobactams: Aztreonam
MoA: Same mode of action as other beta-lactam antibiotics
15. Nitrofurans: Furazolidone
16. Oxazolidonones: Linezolid, Posizolid
MoA: Protein synthesis inhibitor, prevents the initiation step

17. Penicillins: Amoxicillin, Ampicillin, Penicillin G

MoA: Same mode of action as other beta-lactam antibiotics

ABC role in Sexually Transmitted Infection

Abstinence, be faithful, use a condom, also known as the ABC strategy or abstinence-plus sex
education, also known as abstinence-based sex education, is a sex education policy based on a combination
of "risk avoidance" and harm reduction which modifies the approach of abstinence-only sex education by
including education about the value of partner reduction safe sex and birth control methods. The ABC
approach was developed in response to the growing epidemic of HIV/AIDS in Africa, and to prevent the
spread of other sexually transmitted diseases . This approach has been credited by some with the falling
numbers of those infected with AIDS in Uganda, Kenya and Zimbabwe, among others.
Abstinence, be faithful, use a Condom consists of three components:
Abstinence: The ABC approach encourages young adults to delay "sexual debut" (age of first sexual
intercourse), as used by Uganda, or to use abstinence until marriage, the most effective way to avoid
HIV infection, as advocated as the ideal by Christianity and Islam. The program develops skills for
practicing abstinence and encourages participants to adopt social norms that support abstinence
Be Faithful: In addition to abstinence, the ABC approach encourages participants to eliminate casual
or other concurrent sex partners and to practice fidelity within their marriages and other sexual
relationships. This reduces exposure to HIV. In Uganda between 19891995, President
Museveni reported a 20% decline in casual sex partners, and an 11% decline in reported cases of HIV
Use a Condom: The final component to the ABC approach is "correct and consistent condom use."
While understanding the benefits of abstinence, participants are instructed how to apply and use a
condom. This is an example of risk reduction during cases when risk elimination is not practiced.
Students are also taught that condoms do not protect against all forms of sexually transmitted
diseases
Critics argue that in many countries women are frequently infected by their unfaithful husbands while being
faithfully married, and thus women who follow the recommendations of ABC promoters face an increased risk
of HIV infection. Condoms, needles, and negotiation is a proposed alternative approach as is SAVE (Safer
practices, Available medication, Voluntary testing & counselling and Empowerment through education)
Critics furthermore allege that the strategy overlooks the epidemic's social, political, and economic causes
and "vulnerable populations", e.g. sex workers and "those who lack the ability to negotiate safe sex" as well
as risk groups such as homosexuals and intravenous drug users. However, most infections in Africa occur
outside these vulnerable groups, and ABC was a US donor policy only for the "generalized" epidemics in
Africa. Murphy et al. found that Uganda's ABC approach empowered women. "Remarkably, in the 20002001
Uganda DHS, 91 percent of women said they could refuse sex with their husbands if they knew their
husbands had STIs, a somewhat higher percentage than in several other African countries"

Blums Theory in Sexually Transmitted Infection

BHP