Self-Assessment Questions

48. The special cases of syphilis and human immunodeficiency virus

• A 32-year-old woman comes in to the emergency department with fever, myalgias, lymphadenopathy and general malaise. Her pregnancy test comes back positive. Further prenatal lab work also shows infection with syphilis. What potential problems could arise with this pregnancy if the infection is transmitted to her fetus?

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  Correct answer:
  Placental insufficiency resulting from inflammatory changes in the Treponema pallidum infected placenta can lead to intrauterine growth restriction or stillbirth. Fetal hydrops can also develop as a result of compensatory fetal extramedullary hematopoeisis, which is secondary to fetal anemia from a fibrotic liver and spleen. The child born from an infected mother can have the skin rash associated with secondary syphilis, or a runny nasal discharge containing spirochetes. Symptoms of vasculitis, parenchymal damage to the CNS and skeletal abnormalities can also be present in offspring born with congenital syphilis.