Congenital syphilis: still a serious, under-diagnosed threat for children in resource-poor countries
- 140 Downloads
With 700 000 to 1.5 million new cases annually, congenital syphilis remains a major infectious cause of morbidity and mortality in neonates, infants and children in resource-poor countries. We therefore analyzed the extent of congenital syphilis in the pediatric patient population at our rural hospital in Tanzania.
For this retrospective analysis, from January 1, 1998 to August 31, 2000, all cases of congenital syphilis were collected from the medical records of the neonatal and pediatric department at Haydom Lutheran Hospital in rural northern Tanzania. Age, sex, weight, clinical signs and symptoms, venereal disease research laboratory (VDRL) results of mother and/or child, hemoglobin concentration, treatment, and outcome were recorded and analyzed.
Fourteen neonates and infants were included. The earlier the diagnosis, the more it rested on maternal data because the presentation of neonatal congenital syphilis resembled neonatal sepsis. Syphilitic skin lesions were only seen in the post-neonatal age group. VDRL results were positive in 11 of the 14 mothers, and in 4 of the infants. Anemia was common in older infants. No patient showed signs of central nervous system involvement. Two patients died, and the remaining were cured after standard treatment with procaine penicillin.
Highlighting the variable picture of congenital syphilis, this report demonstrates how difficult it is to make a correct diagnosis by solely history and clinical presentation in a resource-poor setting. Hence false-positive and false-negative diagnoses are common, and clinicians have to maintain a high index of suspicion in diagnosing congenital syphilis. Therefore, an important approach to control and finally eliminate congenital syphilis as a major public health problem will be universal on-site syphilis screening of all pregnant women at their first antenatal visit and immediate treatment for those who test positive.
Key wordsclinical diagnosis congenital syphilis prevention resource-poor countries universal screening
Unable to display preview. Download preview PDF.
- 2.UNICEF. Progress for children. A world fit for children. Statistical review no. 6. New York: UNICEF, 2007. (available at http://www.unicef.org/publications/files/Progress_for_Children_No_6_revised.pdf).Google Scholar
- 10.UNAIDS. AIDS epidemic update: December 2007. Geneva: UNAIDS, 2007. (available at http://data.unaids.org/pub/EPISlides/2007/2007_epiupdate_en.pdf)Google Scholar
- 11.Centers for Disease Control and Prevention. Congenital syphilis—United States, 2002.MMWR Morb Mortal Wkly Rep 2004;53:716–719.Google Scholar
- 18.WHO. The global elimination of congenital syphilis: rationale and strategy for action. Geneva: WHO, 2007. (available at http://whqlibdoc.who.int/publications/2007/9789241595858_eng.pdf)Google Scholar
- 19.Hossain M, Broutet N, Hawkes S. The elimination of congenital syphilis: a comparison of the proposed World Health Organization action plan for the elimination of congenital syphilis with existing national maternal and congenital syphilis policies. Sex Transm Dis 2007;34(7 Suppl):S22–30.PubMedGoogle Scholar
- 21.Olsen BE. Motherhood—a hazardous endeavour. Maternal deaths and urinary tract infections in pregnancy in rural northern Tanzania. Doctoral thesis. Bergen: Centre for International Health, Faculty of Medicine, University of Bergen, 2002.Google Scholar
- 22.Haydom Lutheran Hospital. Haydom Lutheran Hospital—Annual reports 1998–2007. Haydom: Haydom Lutheran Hospital, 1999–2008.Google Scholar
- 32.Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2002. MMWR Recomm Rep 2002;51(RR-6):1–78.Google Scholar
- 33.Goh BT, van Voorst Vader PC; European Branch of the International Union against Sexually Transmitted Infection and the European Office of the World Health Organization. European guideline for the management of syphilis. Int J STD AIDS 2001;Suppl 3:14–26.Google Scholar
- 38.National Bureau of Statistics (NBS) [Tanzania] and ORC Macro. Tanzania Demographic and Health Survey 2004–05. Daressalaam, Tanzania: National Bureau of Statistics and ORC Macro, 2005. (available at http://www.measuredhs.com/pubs/pub_details.cfm?ID=566&srchTp=advanced#dfiles)Google Scholar