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• Syphilis and pregnancy in Italy, our experience.
  Roberta Bilenchi
  Published on: 25 November 2005

• Published on: 25 November 2005

  Syphilis and pregnancy in Italy, our experience.

  • Roberta Bilenchi, M.D
  • Other Contributors:
    • S. Poggiali, L. Andreassi, G. Centini° and M. Fimiani.

  Dear Editor,

  Syphilis has long been an important risk factor for adverse pregnancy outcome. According to Mullick et al.[1] maternal syphilis is still a major cause of morbidity and mortality in developing countries. Since there has been a resurgence of syphilis in many developed countries[2], women requiring treatment for syphilis during pregnancy are expected to increase in the United States and Western Europe. In...

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  Dear Editor,

  Syphilis has long been an important risk factor for adverse pregnancy outcome. According to Mullick et al.[1] maternal syphilis is still a major cause of morbidity and mortality in developing countries. Since there has been a resurgence of syphilis in many developed countries[2], women requiring treatment for syphilis during pregnancy are expected to increase in the United States and Western Europe. In Italy[3] the upsurge has been associated with an increase in HIV infection and immigration.[4] However, although antenatal screening for syphilis is routine in Italy before the 13th week of pregnancy, to our knowledge no retrospective analysis of these screening results has ever been carried out and the number of cases of syphilis detected among pregnant women is unknown.

  Siena is a small town but in our venereology unit we recently observed four cases of syphilis in pregnant women born outside Italy (Ecuador, Russian Republic, Senegal and Poland). VDRL (Venereal Disease Research Laboratory) screening was positive in all cases and confirmed by quantitative VDRL and non-treponemal tests that showed high to moderate titres. Physical examination was negative in all cases. Although three patients were multiparous, their children were not born in Italy and none of the patients had a history or documentation of syphilis infection. Unfortunately, we were unable to determine when infection occurred, so all patients were staged ‘secondary latent syphilis of unknown duration’ and immediately treated with three doses per week of i.m. benzathine penicillin (2.4 million units), according to WHO guidelines.[5]

  Quantitative VDRL repeated monthly showed a significant decrease after 3-6 months. The fetuses were monitored by serial three dimensional ultrasonography (GE Voluson 730 Expert Probes) at 22, 30 and 35 weeks (Figure 1). The following parameters were evaluated: biparietal diameter, head circumference, abdominal circumference, femur length, placental thickness, liver size, gestational age, fetal blood pressure, presence of ascites and mucocutaneous manifestations.

  All women delivered after 37 weeks and there were no low-birth-weight infants. Placentas and umbilical cords were normal. The babies were examined clinically and serologically at delivery and at 6, 12 and 15 months and did not show any signs of congenital syphilis. Blood samples were negative for FTA-IgM and other blood tests were within normal limits. The babies were not treated. Passively transferred maternal lipoidal antibodies (VDRL titres) fell by 75% in the first two months and disappeared by about 6 months. Our experience shows that the problem of syphilis in pregnancy is far from solved, even in developed countries. Cases would therefore be missed if antenatal screening were abandoned, especially in women born outside Italy. Appropriate early treatment during pregnancy and meticulous prenatal and postnatal follow up can avoid congenital syphilis and unnecessary penicillin therapy for the infants.

  References:

  1) Mullick S, Watson-Jones D, Beksinska M, Mabey D. Sexually transmitted infections in pregnancy: prevalence, impact on pregnancy outcomes, and approach to treatment in developing countries. Sex Transm Infect. 2005 ;81(4):294-302.

  2) Weir E., Fishman D. Syphilis: have we dropped the ball? CMAJ. 2002 26;167(11):1267-8.

  3) Cusini M., Ghislanzoni M, Bernardi C, Carminati G, Zerboni R, Alessi E, Suligoi B. Syphilis outbreak in Milan, Italy. Sex Transm Infect. 2004;80(2):154.

  4) Suligoi B, Giuliani M. Sexually transmitted diseases among foreigners in Italy. Migration Medicine Study Group. Epidemiol Infect. 1997 ;118(3):235-41.

  5) World Health Organization. Integrating care for reproductive health, sexually transmitted and other reproductive tract infections; a guide to essential practice. Geneva WHO, January 2004.

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  Conflict of Interest:
  None declared.

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