Congenital STI Syndromes

Refers to conjunctival infection of neonates by STI organisms in the infected mother’s birth canal. It is a very serious condition that can lead to corneal ulceration and ultimately to blindness. Blindness in children is associated with high infant morbidity and mortality.

Causes

• Commonly caused by Neisseria gonorrhoeae and Chlamydia trachomatis
• Other non-STI causes of neonatal conjunctivitis predisposed by difficult labour such as early rupture of membranes, vacuum extraction or other assisted vaginal delivery

Clinical features

• Purulent discharge from one or both eyes within 30 days from birth
• Inflamed and swollen eyelids
• Complications of untreated conjuctivitis: corneal ulceration, perforation, scarring and blindness

Investigations

• Pus swab: Gram stain, Culture & Sensitivity

Management

Treatment should cover both gonorrhoea and chlamydia

• Start cleaning with normal saline and apply tetracycline ointment every hour while referring for systemic treatment
• Ceftriaxone 125 mg single dose IM plus azithromycin syrup 20 mg/kg orally, once daily for 3 days
• Irrigate the eyes with saline or sterile water
• Use gloves and wash hands thoroughly after handling the eyelids
• Cover the eye with gauze while opening the eyelid as pus may be under pressure
• Topical tetracycline eye ointment has NO added benefit in active disease
• Treat both parents for Gonorrhoea and Chlamydia and screen for HIV and syphilis

Prevention

• Screen and treat all infected mothers in antenatal care
• Apply prophylactic tetracycline eye ointment 1% to both eyes of ALL newborns at the time of delivery

It is a serious debilitating and disfiguring condition that can be fatal. About one third of syphilis infected mothers have adverse pregnancy outcome, one third give birth to a healthy baby, while the remaining third may result into congenital syphilis

Cause

• Treponema pallidum bacteria

Clinical features

• May be asymptomatic
• Early congenital syphilis: begins to show after 6-8 weeks of delivery
  • Snuffle, palmar/plantar bullae, hepatosplenomegaly, pallor, joint swelling with or without paralysis and cutaneous lesions. These signs are non-specific.
• Late congenital syphilis: begins to show at 2 years
  • Microcephaly, depressed nasal bridge, arched palate, perforated nasal septum, failure to thrive, mental sub normality and musculoskeletal abnormalities

Investigations

Preferably perform the tests on mother:

• VDRL/RPR
• TPHA

Management of congenital syphilis

Treatment

• Assume cerebrospinal involvement in all babies less than 2 years
• Aqueous benzylpenicillin 150,000 IU/kg body weight IV every 12 hours for a total of 10 days
• OR procaine penicillin, 50,000 IU/kg body weight, IM single dose daily for 10 days
• Treat both parents for syphilis with benzathine penicillin 2.4 MU single dose (half on each buttock)

Note

• Assume that infants whose mothers had untreated syphilis or started treatment within 30 days of delivery have congenital syphilis
• If mother is diagnosed with syphilis during pregnancy, use benzathine penicillin as first line since erythromycin does not cross the placental barrier and therefore does not effectively prevent in utero acquisition of congenital syphilis
• Do not use doxycycline in pregnancy

Prevention

• Routine screening and treatment of syphilis infected mothers in antenatal clinics