zithromax and Syphilis--Congenital

Syphilis is a chronic, multi-stage infectious disease that is usually transmitted sexually by contact with an active lesion of a partner or congenitally from an infected pregnant woman to her fetus. Although syphilis is still endemic in many developing countries, it has re-emerged in several developed countries. The resurgence of syphilis is a major concern to global public health, particularly since the lesions of early syphilis increase the risk of acquisition and transmission of infection with human immunodeficiency virus (HIV). Because there is no vaccine to prevent syphilis, control is mainly dependent on the identification and treatment of infected individuals and their contacts with penicillin G, the first-line drug for all stages of syphilis. The emergence of clinically significant azithromycin resistance in Treponema pallidum subsp. pallidum, the syphilis agent, has resulted in treatment failures, thus precluding the routine use of this second-line drug. Information is presented here on the diagnosis and recommended antibiotic treatment of syphilis and the challenge of macrolide-resistant T. pallidum.

Topics: Anti-Bacterial Agents; Azithromycin; Coinfection; Drug Resistance, Bacterial; Female; HIV Infections; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Male; Penicillin G; Pregnancy; Pregnancy Complications, Infectious; Syphilis; Syphilis, Congenital; Treponema pallidum

To evaluate the efficacy of azithromycin in preventing congenital syphilis.. Five pregnant women with syphilis who were allergic to penicillin were given azithromycin, 1 g daily orally or intravenously, in different hospitals. The duration of the therapy ranged from 1 day to 10 days. A second course of therapy was provided at 28 weeks gestation. The babies were given a physical examination and blood test for serum rapid plasma reagin test (RPR), treponema pallidum hemagglutination test (TPHA), and fluorescent treponemal antibody adsorption test (FTA-ABS-19-sIgM) within three months after birth.. Five infants born to these mothers developed skin rashes. Four of the infants had hepatomegaly and one showed osteochondritis. The tests RPR, TPHA, and FTA-ABS-19-sIgM were positive. The RPR titers varied from 1:64 to 1:256 and the babies were diagnosed with congenital syphilis. They were successfully treated with penicillin.. Successful therapy for syphilis during pregnancy demands maternal care as well as prevention or cure of congenital infection. The failure of azithromycin in preventing congenital syphilis in our report suggests that azithromycin should not be recommended as an alternative in treating syphilitic pregnant women or fetal syphilis.

Topics: Administration, Oral; Adult; Anti-Bacterial Agents; Azithromycin; China; Drug Administration Schedule; Female; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Infusions, Intravenous; Male; Pregnancy; Pregnancy Complications, Infectious; Prenatal Care; Syphilis; Syphilis Serodiagnosis; Syphilis, Congenital

Topics: Administration, Oral; Anti-Bacterial Agents; Azithromycin; Drug Resistance, Bacterial; Female; Humans; Pregnancy; Pregnancy Complications, Infectious; Syphilis; Syphilis, Congenital; Treponema pallidum

Topics: Anti-Bacterial Agents; Azithromycin; Humans; Mass Screening; Syphilis; Syphilis Serodiagnosis; Syphilis, Congenital; Treponema pallidum