CONGENITAL SYPHILIS

Mom: 21yrs, Am. Ind., Non-Hisp No regular prenatal care

o 1st visit 11-15-13o Last visit 1-29-14

4-14-14 presents at small hospital for L& D Dr. notices labial sore, and questions patient Patient states that the sore “had been there a

while” and it wasn’t too painful.

Labs Ordered and Results: 11-15-13 – RPR was non reactive 11-15-13 – Gonorrhea+ 11-15-13 – Chlamydia and HIV – 4-14-14 – RPR 1:64, TPPA reactive 4-14-14 – CT/GC negative

Treatment: 11-15-13 250mg Rocephin, 1gm

Zith 4-15-14 2.4 mU Bicillin

Congenital Case #1

Born 4-14-14 Healthy weight and length No congenital deformities No chancres, rash, or mucosal S/S 4-15-14 unresolved fever

Baby was transferred to NICU at a larger hospital

Labs Ordered and Results: 4-15-14 Lumbar puncture – WBC, CBC, protein, glucose all

within normal limits. RPR and TPPA non reactive. 4-15-14 Blood draw (non-umbilical) RPR 1:8 TPPA reactive 4-15-14 Long Bone Survey – Normal Treatment: 4-16-14 IV Penicillin 150,000 units/kg/day for 10 days

Congenital Case #2Mom: 16yrs, Am. Ind., Non-Hisp No early prenatal care Regular 3rd trimester care

No vaginal exams 5-28-14 presents for 38 week visit.

Labs Ordered and Results: 8-8-13 Chlamydia +, GC – 11-20-13 RPR Non-reactive 11-20-13 Gonorrhea + 11-20-13 Chlamydia and HIV – 5-28-14 RPR 1:256, TPPA reactive

Treatment: 8-15-13 1gm Zith 11-20-13 250 mg Rocephin and 1 gm

Zith 6-4-14 2.4 mU Bicillin

Dr. refers mom for C-section and NICU for baby.

Vaginal exam 6-6-14, prior to C-section, healing lesion seen.

Born 6-5-14 Healthy weight and length No congenital deformities No chancres, rash, or mucosal S/S

Labs Ordered and Results: 6-6-14 Lumbar puncture – WBC, CBC, protein, glucose all within

normal limits. RPR and TPPA non reactive. 6-6-14 Blood draw (non-umbilical) RPR 1:8 TPPA reactive 6-6-14 Long Bone Survey - Normal

Treatment:6-6-14 IV Penicillin 150,000 units/kg/day for 10 days

Congenital Case #3

Mom: 25yrs, White, Non-Hisp Regular prenatal appointments No current S/S No recollection of past S/S 3-12-14 presents for 24 week care

Labs Ordered and Results: 3-12-14 RPR 1:64, no TPPA done 3-25-14 RPR 1:128, TPPA reactive 5-12-14 RPR 1:64, TPPA reactive 8-4-14 RPR 1:64, TPPA reactive Additional labs pending

Treatment: 3-24-14 2.4 mU Bicillin 4-7-14 2.4 mU Bicillin 5-21-14 2.4 mU Bicillin

Concerns: Re-infection Treatment failure

Born 6-5-14 via C-section Healthy weight and length No congenital deformities No chancres, rash, or mucosal S/S

Labs Ordered and Results: 7-22-14 Blood draw (non-umbilical) RPR 1:16, TPPA reactive 7-23-14 Lumbar puncture -- WBC, CBC, protein, glucose all

within normal limits. RPR and TPPA non reactive. 7-23-14 Long Bone Survey – consistent with Congenital Syphilis

Treatment: 7-23-14 IV Penicillin 200,000 units/kg/day for 10 days

(Suspect) Congenital Case #4

Mom: 22yrs, Am. Ind., Non-Hisp 7-28-14, 1st prenatal

appointment at 12 weeks “Kissing” lesions & alopecia

Labs Ordered & Results: 7-28-14 RPR 1:128, TPPA

Reactive 7-28-14 CT +, GC +, HIV -

Treatment: 8-1-14 250mg Rocephin, 1gm

Zith, 2.4 mU Bicillin

Fetus: No heartbeat detected on 8-11-

14

Is this the end of our Congenital

Cases?Amanda Gill M.S.

South Dakota Dept. of HealthSTD Program Manager

amanda.gill@state.sd.us605-773-4794605-280-4793