It has been many years since a case of
congenital syphilis has been reported in Utah. Unfortunately, in the past several months,
we have had two presumptive cases reported. The first case involved a mother who received
prenatal care late in pregnancy. A routine screening test revealed that she had an
untreated case of syphilis and she received adequate treatment during her ninth month of
pregnancy. The infant was asymptomatic at the time of delivery and received presumptive
treatment for congenital syphilis based upon the fact that the mother was treated for
syphilis less than a month before delivery.
The most recent case involved a woman who
sought prenatal care well into her seventh month of pregnancy. A serological test for
syphilis was not performed prior to delivery. Following delivery, the mothers
primary care physician became aware of the oversight and ordered a full prenatal panel. At
that time it was determined that she was infected with syphilis. Around the same time, the
baby exhibited symptoms that were compatible with syphilis (although viral meningitis
could not be ruled out). In light of the mothers status and symptoms that were
compatible with congenital syphilis, the infant was treated with penicillin for ten days.
The mother also received treatment for latent syphilis of unknown duration.
"No infant should leave the
hospital without the maternal serologic
status having been determined for syphilis."
In the past, syphilis accounted for nearly
one-third of stillbirths. Many of these mothers had inadequate prenatal care and thus went
undiagnosed. Today, syphilis has a much smaller role in fetal death.
Spirochetes readily cross the placenta and can result in congenital
infection. The frequency of congenital syphilis varies with both the stage and duration of
maternal infection. Although any stage of maternal syphilis may result in fetal infection
the highest incidence occurs in neonates born to mothers with early syphilis and the
lowest incidence occurs in neonates born to mothers with late latent syphilis.
Testing for syphilis in a pregnant woman is required by law (Utah Code
Annotated. 26-6-20). Effective prevention and detection of congenital syphilis depends on
the identification of syphilis as early as possible during pregnancy. Therefore, a
serologic screening test such as the VDRL or RPR should be performed at the first prenatal
visit. Because the VDRL and RPR lack specificity, treponemal tests such as the FTA-ABS or
MHA-TP should be used to confirm a positive result. For women at high risk, a second
nontreponemal test should be performed during the third trimester. No infant should leave
the hospital without the maternal serologic status having been determined for syphilis.
As part of the management of pregnant women who have syphilis,
information concerning treatment of their sex partners should also be obtained.
There are no proven alternatives to
penicillin during pregnancy, thus a regimen using penicillin remains the treatment of
choice. Erythromycin may be curative in the mother, but may not prevent congenital
syphilis. Pregnant patients who are allergic to penicillin should be desensitized and
treated with penicillin.
Infants with suspected or proven congenital syphilis should have a
cerebrospinal fluid examination prior to treatment and should be followed at monthly
intervals until nontreponemal serologic tests become negative or serofast.
FOR SYPHILIS IN ADULTS
EARLY LATENT SYPHILIS DURATION < 1 YEAR
Benzathine penicillin G 2.4 m.u/ IM
in a single dose
Doxycycline 100mg orally twice a day for 2 weeks
Tetracycline 500mg four times a day for 2 weeks
LATE LATENT SYPHILIS OR LATENT SYPHILIS OF UNKNOWN
Benzathine penicillin G 7.2 m.u./IM
administered as three doses of 2.4 m.u./IM each at one week intervals
Doxycycline 100mg orally twice a day for 4 weeks
Tetracycline 500mg four times a day for 4 weeks
Aqueous crystalline penicillin G
100,000-150,000 units/kg/day, administered as 50,000 units/kg/ dose IV every 12 hours
during the first 7 days of life, and every 8 hours thereafter for a total of 10 days
Procaine penicillin G 50,000 units/kg/dose IM a day in a single dose for 10 days
Infants should be treated for presumptive congenital syphilis if
they were born to mothers who meet the following criteria:
had untreated syphilis at delivery;
had serologic evidence of relapse or reinfection after
was treated with erythromycin or other nonpenicillin regimen for
syphilis during pregnancy;
was treated for syphilis less than one month before delivery;
did not have a well documented history of treatment for
was treated for early syphilis during pregnancy with the
appropriate penicillin regimen, but nontreponemal antibody titers did not decrease at
was treated appropriately before pregnancy but had insufficient
serologic follow-up to ensure an adequate treatment response and lack of current
The 1998 Guidelines for Treatment of Sexually Transmitted
Diseases are available.
Tips (Adapted from Utah State University
Extensions Wildlife Management Series, "Bats")
Bats are an important part of Utahs ecosystems, and they are directly
beneficial to humans as they consume 30-100% of their weight in insects each night!
However, direct human-bat encounters are dangerous because bats can transmit rabies.
Rabies is rare in bats (it occurs in less than 1% of bats), but is fatal to humans.
Although uncommon in Utah, bats can also transmit a fungal disease called histoplasmosis.
Bats are shy animals and normally avoid contact with humans. A bat
that is active during the day or moving so slowly that it can be caught is likely to be
sick and should be avoided. Unwanted human-bat encounters also occur when bats get
into houses or other buildings. Bats do not chew holes in buildings but can enter through
existing openings that are as small as 1/4 inch (5 millimeters)! Bats can also enter
through open doors and windows, loose or torn screens, or gaps around attic doors.
What to do if a bat is found inside a building:
1. If the bat has bitten someone, OR if you find the bat in a
room with someone who is unable to give a reliable history of whether they have had
contact with the bat or not (i.e., a young child or mentally challenged adult, a sleeping
person, or someone under the influence of drugs or alcohol), you need to make every
attempt to safely capture the bat alive using the container technique described below
(2b). The captured bat should then be tested for rabies.
2. If you are certain that the bat has had no contact with
anyone in the building:
a. If it is flying around, you can open an
outside door or window and wait for the bat to exit.
b. If it lands, you can place a jar or other
container over the bat, slide a piece of heavy cardboard under the mouth of the
container, and trap the bat
inside. The bat can then be released outside away from children and pets.
The best way to keep bats from entering buildings is to locate and seal
any openings the bats could be using. The fall is the best time to bat-proof a
building as this is the time of year when most bats vacate their nests (so you dont
run the risk of trapping young flightless bats which will die without food and create a
subsequent odor problem). A variety of materials, such as caulk, foam rubber, or steel
wool can be used to fill in small holes, and materials such as metal screening or tar
paper can be used to cover over larger holes.
Remember, all bats are protected under Utah law and it is illegal to
intentionally kill a bat. Bat-proofing of buildings and other prudent human behavior can
prevent some (but not all, unfortunately) unwanted human-bat encounters.
Report of Diseases of Low Frequency
Year-to-Date January 1 - September 30, 1998
(including a comparison for same time period 1994 -1997)
Utah Department of
Health, Bureau of Epidemiology
Morbidity Summary - September 1998 - Provisional Data
The Epidemiology Newsletter is published monthly by the
Utah Department of Health, Division of Epidemiology and Laboratory Services, Bureau of
Epidemiology, to disseminate epidemiologic information to the health care professional and
the general public.
Send comments to:
The Bureau of Epidemiology
Salt Lake City, UT 84114-2104
or call (801) 538-6191
Rod Betit, Executive Director Utah Department of Health
Charles Brokopp, Dr.P.H. Division of Epidemiology and Laboratory Services
Craig R Nichols, MPA, Editor, State Epidemiologist, Director Bureau of Epidemiology
Cristie Chesler, BA Managing Editor