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Incidence and associated factors of congenital syphilis at a tertiary care center in Thailand

Pimchanok Kulsirichawaroj
Pimchanok Kulsirichawaroj
 und 
Dissajee Lumbiganon
Dissajee Lumbiganon
   | 07. Aug. 2023
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Article Category: Original article
Online veröffentlicht: 07. Aug. 2023
Seitenbereich: 13 - 21
DOI: https://doi.org/10.2478/abm-2023-0039
Schlüsselwörter
© 2023 Pimchanok Kulsirichawaroj et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

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
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