A-Z Index × Submit A-Z Index × Submit A-Z Index Search Dropdown × Submit Facebook Twitter LinkedIn Syndicate Emerging Infectious Disease journal ISSN: 1080-6059 Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released.
We describe congenital syphilis in a newborn whose mother had secondary syphilis diagnosed during pregnancy and received a single penicillin dose. Molecular methods detected an extremely low Treponema pallidum load in the mother but higher load in the neonate. Our findings support use of molecular methods for detecting vertical T. pallidum transmission.
Syphilis is an infectious bacterial disease caused by Treponema pallidum subspecies pallidum . Mother-to-child transmission, known as congenital syphilis (CS), can result in severe adverse outcomes, including fetal and neonatal death, stillbirth, and preterm or low-birthweight births ( 1 ). Gestational syphilis and CS diagnoses rely on a combination of treponemal and nontreponemal serologic tests ( 1 – 3 ). However, those methods can yield false-negative results, particularly in early disease stages, because of low initial bacterial load, prozone effect (primarily in secondary syphilis), or co-occurrence with other diseases ( 2 ). We describe a case of vertical neonatal T. pallidum transmission in Bogotá, Colombia, and use of enhanced molecular methods for CS diagnosis.
A 27-year-old pregnant woman was admitted to Meissen Hospital in Bogotá for threatened preterm labor at 32-weeks’ gestation on the basis of third-trimester ultrasound. She had a history of 3 previous pregnancies, including a stillbirth. She reported receiving no prenatal care during this pregnancy and a previous syphilis diagnosis with a nontreponemal Venereal Disease Research Laboratory (VDRL) titer of 1:4 but was unsure whether she received treatment. Physical examination revealed widespread, well-defined desquamative skin lesions, initially suggestive of psoriasis. At admission, a positive treponemal test and a VDRL titer of 1:2 led to a diagnosis of latent syphilis of unknown duration. She was prescribed 3 doses of 2,400,000 IU of benzathine penicillin, administered weekly. However, she received only the first dose because she requested a voluntary discharge. Thirty-six days later, she was re-admitted in the expulsive stage of labor but had not received further penicillin doses. Urine toxicology was positive for cocaine and cannabinoids. Her VDRL titer remained at 1:2 and her benzathine penicillin regimen was reinitiated. She again requested voluntary discharge before completing treatment ( Appendix ).
Figure . Comparison of testing results for detection of congenital syphilis via dPCR and NGS, Colombia. The Treponema pallidum tp0547 gene concentration was calculated by the dPCR platform software, and NGS...