Clinical, radiologic, complete blood count and CSF findings of 40 neonates with congenital syphilis†
| Findings | n (%) |
|---|---|
| Abnormal physical examinations‡ (14/40 cases=35.0%) | |
| Skin desquamation | 7 (17.5%) |
| Hepatosplenomegaly | 4 (10.0%) |
| Rash | 3 (7.5%) |
| Petechiae | 2 (5%) |
| Abnormal radiologic findings§ (6/32 cases=18.8%) | |
| Cortical erosion | 1 (3.1%) |
| Osteolytic lesion | 1 (3.1%) |
| Radiolucent line at metaphyseal plate (osteitis) | 5 (15.6%) |
| Abnormal complete blood counts (7/40 cases=17.5%) | |
| Anemia (Hematocrit < 40%) | 2 (5 %) |
| Thrombocytopenia (Platelet < 150,000) | 7 (17.5%) |
| Abnormal CSF fluid examinations|| (30/35 cases= 85.7%) | |
| CSF Pleocytosis (CSF WBC > 15 cells/mm3) | 13 (37.1%) |
| Elevated CSF protein (CSF protein > 120 mg/dL) | 20 (57.1%) |
| Positive CSF VDRL | 2 (5.7%) |
Maternal and neonatal characteristics of 126 neonates born to mothers with syphilis_
| Characteristics | Case (N = 40) | Control (N = 86) | Total (N = 126) |
|---|---|---|---|
| n (%) | n (%) | n (%) | |
| Maternal characteristics | |||
| Age (years) | |||
| <20 | 17 (42.5) | 30 (34.9) | 47 (37.3) |
| 20–34 | 19 (47.5) | 45 (52.3) | 64 (50.8) |
| ≥35 | 4 (10.0) | 11 (12.8) | 15 (11.9) |
| Median (IQR) | 20 (18–22.5) | 21 (18–25) | 20 (18–24) |
| Ethnicity | |||
| Thai | 37 (92.5) | 82 (95.3) | 119 (94.4) |
| Others | 3 (7.5) | 4 (4.7) | 7 (5.6) |
| Education (n = 60) | |||
| Primary school | 3 (33.3) | 16 (31.4) | 19 (31.7) |
| Secondary school | 6 (66.7) | 33 (64.7) | 39 (65.0) |
| Bachelor degree or higher | 0 (0.0) | 2 (3.9) | 2 (3.3) |
| Maternal co-infection | |||
| HIV | 2 (5.0) | 2 (2.3) | 4 (3.2) |
| Hepatitis B | 1 (2.5) | 1 (1.2) | 2 (1.6) |
| Antenatal care† | |||
| Yes | 36 (90.0) | 79 (91.9) | 115 (91.3) |
| No | 4 (10.0) | 7 (8.1) | 11 (8.7) |
| Maternal treatment | |||
| Adequate | 14 (35.0) | 51 (59.3) | 65 (51.6) |
| Inadequate | 13 (32.5) | 17 (19.8) | 30 (23.8) |
| No treatment | 13 (32.5) | 18 (20.9) | 31 (24.6) |
| Mode of delivery | |||
| Vaginal | 31 (77.5) | 57 (66.3) | 88 (69.8) |
| Cesarean section | 9 (22.5) | 26 (30.2) | 35 (27.8) |
| Vacuum extraction | 0 (0.0) | 3 (3.5) | 3 (2.4) |
| Neonatal characteristics | |||
| Sex: Male | 22 (55.0) | 39 (45.3) | 61 (48.4) |
| Gestational age (weeks) | |||
| <37 | 13 (32.5) | 10 (11.6) | 24 (19.0) |
| 37–42 | 27 (67.5) | 74 (86.0) | 100 (79.4) |
| >42 | 0 (0.0) | 2 (2.3) | 2 (1.6) |
| mean ± SD | 37.05 ± 2.81 | 38.02 ± 2.36 | 37.73 ± 2.55 |
| Birth weight (grams) | |||
| <1000 | 1 (2.5%) | 0 (0.0%) | 1 (0.8%) |
| 1001–1500 | 1 (2.5%) | 1 (1.2%) | 2 (1.6%) |
| 1501–2000 | 3 (7.5%) | 4 (4.7%) | 7 (5.6%) |
| 2001–2500 | 7 (17.5%) | 8 (9.3%) | 15 (11.9%) |
| >2500 | 28 (70.0%) | 73 (84.9%) | 101 (80.2) |
| mean ± SD | 2753.98 ± 680.87 | 2882.78 ± 490.16 | 2841.89 ± 558.24 |
| Low birth weight (<2500 grams) | |||
| Yes | 12 (30.0%) | 13 (15.1%) | 25 (19.8%) |
| No | 28 (70.0%) | 73 (84.9%) | 101 (80.2%) |
| Birth weight for GA | |||
| SGA | 2 (5.0%) | 3 (3.5%) | 5 (4.0%) |
| AGA | 37 (92.5%) | 81 (94.2%) | 118 (93.7%) |
| LGA | 1 (2.5%) | 2 (2.3%) | 3 (2.4%) |
| Birth asphyxia‡ | |||
| No | 34 (85.5%) | 78 (90.7%) | 112 (88.9%) |
| Yes | 6 (15.0%) | 8 (9.3%) | 14 (11.1%) |
Univariable and multivariable analysis for factors associated with congenital syphilis in neonates born to mothers with syphilis_
| Characteristics | Case (N = 40) | Control (N = 86) | OR† | 95% CI | P | OR‡ | 95% CI | P | |
|---|---|---|---|---|---|---|---|---|---|
| Maternal Age, years | |||||||||
| <20 | 19 (47.5%) | 30 (24.9%) | 1.00 | Reference | |||||
| 20–34 | 17 (42.5%) | 45 (52.3%) | 1.34 | 0.60–2.99 | 0.472 | ||||
| ≥35 | 4 (10.0%) | 11 (12.8%) | 0.86 | 0.24–3.05 | 0.817 | ||||
| 1st ANC visit | |||||||||
| 1st trimester | 10 (25%) | 32 (37.2%) | 1.00 | Reference | |||||
| 2nd or 3rd trimester | 26 (65%) | 47 (54.7%) | 1.77 | 0.75–4.17 | 0.191 | ||||
| No ANC | 4 (10%) | 7 (8.1%) | 1.83 | 0.44–7.56 | 0.404 | ||||
| Maternal RPR before delivery | |||||||||
| <1:8 | 14 (35.0%) | 48 (55.8%) | 1 | Reference | 1.0 | Reference | |||
| >1:8 | 23 (57.7%) | 32 (37.2%) | 2.46 | 1.11–5.49 | 0.027 | 2.01 | 0.87–4.68 | 0.105 | |
| Non-reactive | 3 (7.5%) | 6 (7.0%) | 1.71 | 0.38–7.75 | 0.484 | 1.01 | 0.19–5.30 | 0.989 | |
| Maternal treatment | |||||||||
| Adequate | 14 (35.0%) | 51 (59.3%) | 1.00 | Reference | 1.0 | Reference | |||
| Inadequate | 13 (32.5%) | 17 (19.8%) | 2.79 | 1.10–7.08 | 0.031 | 2.69 | 1.02–7.11 | 0.046 | |
| No treatment | 13 (32.5%) | 18 (20.9%) | 2.63 | 1.04–6.65 | 0.041 | 1.84 | 0.65–5.17 | 0.248 | |
| Mode of delivery | |||||||||
| Cesarean section/vacuum extraction | 9 (22.5%) | 29 (33.7%) | 1.00 | Reference | |||||
| Vaginal | 31 (77.5%) | 57 (66.3%) | 1.75 | 0.74–4.17 | 0.204 | ||||
| Preterm birth | |||||||||
| No | 27 (67.5%) | 76 (88.4%) | 1.00 | Reference | 1.0 | Reference | |||
| Yes | 13 (32.5%) | 10 (11.6%) | 3.66 | 1.44–9.31 | 0.006 | 2.91 | 1.01–8.39 | 0.049 | |
| Birth weight | |||||||||
| >2,500 g | 28 (70%) | 73 (84.9%) | 1.00 | Reference | |||||
| <2,500 g | 12 (30%) | 13 (15.1%) | 2.41 | 0.98–5.90 | 0.56 | ||||
Total live births, neonates born to mothers with syphilis and number of neonates diagnosed with congenital syphilis by year of birth_
| Year of birth | Total live births | Number of neonates born to mothers with syphilis (%) | Neonates diagnosed with congenital syphilis† | Rate of congenital syphilis transmission (%) | Incidence of congenital syphilis per 100,000 live births |
|---|---|---|---|---|---|
| 2011 | 3,070 | 6 (0.2) | 2 | 33.3 | 65.14 |
| 2012 | 2,945 | 4 (1.3) | 1 | 25.0 | 33.95 |
| 2013 | 2,664 | 6 (0.2) | 2 | 33.3 | 75.08 |
| 2014 | 2,534 | 8 (0.3) | 5 | 62.5 | 197.32 |
| 2015 | 2,154 | 9 (0.4) | 6 | 66.7 | 278.55 |
| 2016 | 2,115 | 33 (1.5) | 9 | 27.3 | 425.53 |
| 2017 | 2,064 | 34 (1.6) | 7 | 20.5 | 339.14 |
| 2018 | 2,012 | 26 (1.3) | 8 | 30.8 | 397.61 |
| Total | 19,558 | 126 (0.6) | 40 | 31.7 | 204.52 |