Gestational and congenital syphilis: gaps to be elucidated

Carvalho, Déborah Esteves; Pimentel, João Victor Andrade; Silva, Luise Oliveira Ribeiro da; Rodrigues, Letícia Maria Cardoso Lima; Andrade, Leonardo Santana; Santana, Carlos Ramon Costa; Menezes, Marcelo Antônio Silva; Silva, Eloyse Emanuelle Nunes; Santos, Gabryelle Eduarda Gama dos; Santos, Sayron Natanael Lopes Pereira; Gomes, Breno Gustavo do Nascimento; Meira, Letícia Almeida; Santos, Helga Machado de Farias; Lopes, Izailza Matos Dantas

doi:10.1590/0037-8682-0038-2023

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Case Report • Rev. Soc. Bras. Med. Trop. 56 • 2023 • https://doi.org/10.1590/0037-8682-0038-2023 copy

Gestational and congenital syphilis: gaps to be elucidated

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Congenital and gestational syphilis are increasingly prevalent multisystemic infections in Brazil. This study aimed to present a case series of three children diagnosed with congenital syphilis even though their mother had unreactive treponemal tests. The VDRL (Venereal Disease Research Laboratory) titers of a 22-year-old mother with three pregnancies decreased after treatment. The mother did not have a reactive treponemal test, but all the three children were diagnosed with early congenital syphilis. This case series highlights the difficulty in diagnosing gestational and congenital syphilis in Brazil.

Keywords:
Gestational syphilis; Treponemal tests; Early congenital syphilis

Periods	First pregnancy	Second pregnancy	Third pregnancy
First trimester	not reported	not reported	VDRL 1/4
			FTA-ABS IgG and IgM non-reactive
Third quarter	VDRL 1/16	VDRL 1/16	VDRL 1/2
	(pre-treatment titration, when benzathine penicillin 2.4 million IU was started with three doses and 7-day interval)	FTA-AB IgG and IgM non-reactive	(Others not performed)
		(pre-treatment titration, when six doses of benzathine penicillin 1.2 million IU were started with a 7-day interval)
One month before delivery	not reported	VDRL 1/2	not reported
		(post-treatment titration)
At childbirth	VDRL 1/8 (post treatment titration)	VDRL 1/2	VDRL 1/8
			Negative rapid test
			(pre-treatment titration, when six doses of benzathine penicillin 1.2 million IU were started with a 7-day interval)
Three months postpartum	VDRL 1/16	not reported	VDRL 1/2
			(post treatment titration)
One year after giving birth	non-reactive VDRL	VDRL 1/32 (Others not performed)	not reported
	FTA-ABS IgG and IgM non-reactive
One year and 3 months after giving birth	VDRL 1/32.	not reported	not reported
	FTA-ABS IgG and IgM non-reactive

	First child	Second child	Third child
At birth	Radiodensity changes in all long bones	Metaphyseal changes in all long bones	Metaphyseal changes in all long bones
6 months	Epiphyseal osteosclerosis in all long bones
12 months		Metaphyseal changes in all long bones
24 months	Metaphyseal osteosclerosis in all long bones
36 months	Metaphyseal osteosclerosis in all long bones	Metaphyseal changes in all long bones
60 months	Without changes

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[1] Corresponding author: João Victor Andrade Pimentel. e-mail:jvapimentel0@gmail.com