TESTIMONIAL for Syphilis

17 years..…. born in 2000….. without education…..with black hands because of the iodine in green nut shells, a sign of how it wins its existence…

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Neonatal Syphilis Case presentation = Real events spent in the summer of 2017 in Ploiesti, Romania

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The case presented is a female patient born in the year 2000, in Prahova County, Romania.

The patient has a poor social condition and an impressive sexual life history at just 17 years. The patient began her sexual life at the age of 13 on the occasion of sexual abuse.

At age of 15 years, she thought she had found a life partner, a man exited out of prison, tattooed, many years older than her, but who will put his print on her future.

At 16, she finds a 20 year old partner and together they decide to do a baby.

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Thus, in May 2017, she presented himself at the guard service of an Obstetrics and Gynecology hospital in Ploiesti, with fever, myalgia, headache, lombo-abdominal pain, bed smelling vaginal secretion. Is interned and established to be at the first pregnancy and the first birth and is 25 weeks pregnant. Is identified a threat of premature birth, an acute infection of the upper respiratory tracts and infection with Gardnerella Vaginalis. At the syphilis diagnostic exam, the positive VDRL serology is observed (VDRL is an unspecific, non-treponemic test, which is made as first intention of syphilis diagnosis. If the test is positive the diagnosis continues with specific treponemic tests, for confirmation).

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Because the hospital protocol (valid in any hospital in Romania) requires all pregnancies to be hospitalized to perform non-treponemal tests (VDRL) to diagnose syphilis and the patient is found positive with anticardiolipin antibodies, there is suspicion of an infection with Treponema Pallidum, the etiologic agent in syphilis and, for confirmation, the blood is collected and sent to the Public Health Directorate (DSP) for specific treponema tests and completion of the syphilis diagnosis. Here are made TPHA (Treponemic Passive Haemagglutination Test, Reactive-TPHA Syphilis Dialab), RPR (Non-Treponemic Flocculation Test, Reactive-RPR Test Kit Fortress DG), VDRL (Non- Treponemic Flocculation Assay, Cardiolipin-reactive antigens – Cantacuzino Institute). The results of all tests are positive. The patient, in our case a 17-year-old pregnant woman, is diagnosed with syphilis.

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         In the hospital, at the time of admission is treated for comorbidities, (i.e. for the conditions present at that institution), is given antispasmodic treatment (No-SPA 1 ampoule at 8 hours, Uscosin 1suppository at 8 hours), antibiotic (ampicillin 1g to 8 hours). It shall be discharged after 5 days of hospitalization, with a general good condition and with the recommendation to consult for the treatment of syphilis in a dermatological cabinet. Because of the poor economic status, the patient is delaying the dermatological consultation, the cause being the impossibility to pay for the consultations. It is directed to a family doctor who releases a referral note and thus arrives at a dermatological clinic. After the clinical and laboratory examination, the dermatologist puts the diagnosis of late latent syphilis. The partner is also tested (TPHA, VDRL and VDRL quantitative dilution) But the result is negative for all tests. Corroborating these data, one can say that she has contracted syphilis when she had a sexual relationship with her recidivist or history partner.

The dermatologist indicates treatment with 7.2 million IU Moldamin dosages as follows: 1.2 million IU in each buttock (2.4 mil) every 7 days, 3 doses, with test at first dose. She is also being treated with topical treatment with Miconazole ointment for syphilis rosoles on the body. The dermatologist gives her the indication to repeat serology VDRL every 3 months in the first year and every 6 months in the second year.

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After a month, in June 2017, she presented herself in the emergency service of the obstetrics and gynecology hospital with painful uterine contractions that succumb to antispasmodics. She is diagnosed with primary pregnancy, 37 weeks pregnancy, live fetus, cranial presentation, intact membranes. False labor. VDRL positive.

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On August 23, 2017, 21:20 is in maternity for birth. The pregnancy has 41 weeks, the fetus is alive, the presentation is cranial, the membranes intact. VDRL positive observation. The next day, August 24 spontaneously ruptures the membranes, and at 12.50 birth spontaneously, a living fetus, female, weighing 2700 grams, Apgar 9. The fetus has lesions on both hands, specific to syphilis

 In the birthing hall the new mother receives treatment with Uterotonics (Ergomet, oxytocin) and infusion solutions (glucose 5%, physiological serum) to compensate the blood loss during birth. Post partum receives treatment with amoxicillin 1 gram to 8 hours, Ergomet 1 ampoule to 8 hours. On the occasion of admission, blood is collected for CBC and Serology. Result: HLG-Hb-12g/dl, Ht-36.32%, leukocyte-9,94 * 1000microL, VDRL-positive, anti-AIDS-negative. Also, a summary urinalysis is performed, with normal values, ​​and bacteriological examination of the cervix secretion, with a positive result, Escherichia Coli colonies sensitive to Amoxicillin were developed.

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Due to the history of the mother (VDRL, TPHA-positive) the newborn is also tested , but there are also collected samples form the mother to be sent to the DSP.  The results are as follows:

Newborn    

  -Test TPHA (passive haemagglutination, reagents-TPHA siphylis Dialab)-positive, appearance 3 +

  -Test RPR (non-treponemic test of flocculation, reagents-RPR test Kit Fortress DG)-positive, dilution ½

  -Test VDRL (nontreonemic test of flocculation, reagents – Cardiolipin Antigen Cantacuzino Institute)-Positive, dilution ½

Mother    

 -Test TPHA (passive haemagglutination, reagents-TPHA SiphylisDialab)-positive, appearance 3 +

 -Test RPR (non-treponemic test of flocculation, reagents-RPR test Kit Fortress DG)-Positive, dilutie1/8

 -Test VDRL (non-treonemic test of flocculation, reagents – Cardiolipin antigen Cantacuzino Institute)-Positive, dilution 1/8

The newborn presents water blisters on both hands, inferior to the anatomical box, and that is why the culture sample is collected at the lesion level (to indicate that the lamella test is not performed in the hospital for viewing Treponema pallidum in dark field). 

Both the cultures from lesions and the pharynx exudate collected in the newborn at birth are sterile. Start treatment of the newborn with penicillin G sodium 100 000 IU intravenously at 12 hours for 7 days and at 8 hours intravenously in the next 7 days. During the entire period of treatment the newborn and mother remain in hospital.

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     On September 7, 2017 they are both discharged with good general status and recommendation to go for monitoring and continuation of antibiotic therapy, ambulatory at a cabinet of dermatoveneric diseases cabinet