Acquired Syphilis by Nonsexual Contact in Childhood.
Journal
The Pediatric infectious disease journal
ISSN: 1532-0987
Titre abrégé: Pediatr Infect Dis J
Pays: United States
ID NLM: 8701858
Informations de publication
Date de publication:
01 10 2021
01 10 2021
Historique:
pubmed:
27
7
2021
medline:
20
1
2022
entrez:
26
7
2021
Statut:
ppublish
Résumé
Children may acquire syphilis by nonsexual contact as a consequence of close and repetitive contact with mucosal or skin lesions of people with active syphilis. Prospective cohort study of pediatric patients with acquired syphilis by nonsexual contact. Demographics, clinical findings, posttreatment serology development and general laboratory data were collected. Sexual transmission was ruled out after a careful medical and psychosocial evaluation of the patient and his/her family. Twenty-four patients were included in the study. Mean age at diagnosis was 4.2 years old. All of them came from overcrowded households with poor hygiene conditions. The most frequent reason for consultations was secondary syphilis skin lesions (79.2%). The psychosocial evaluation of children and their families did not reveal signs of sexual abuse in any of the cases. Seventy-eight families and their cohabitants were evaluated, 23 (29.5%) resulted positive for rapid plasma reagin and treponemal test of hemagglutination; 60.9% of the cases were asymptomatic. The symptomatic relatives showed lesions of secondary syphilis. A sustained fall on nontreponemal antibodies titer (rapid plasma reagin) was observed after treatment, becoming negative in 6/24 (25%) cases within 12 months posttreatment. Following evaluation, it was considered that sexual abuse was unlikely. However, if examination and psychosocial evaluation do not support it, other ways of transmission must be considered. Overcrowded and poor household conditions boost the risks for nonsexual treponema transmission. An infected member of the family or a caretaker are a particular risk to an infant due to common practices such as using saliva to moisten the rubber nipples of the milk bottles or trying the food temperature using the lips before feeding the infants.
Sections du résumé
BACKGROUND
Children may acquire syphilis by nonsexual contact as a consequence of close and repetitive contact with mucosal or skin lesions of people with active syphilis.
METHODS
Prospective cohort study of pediatric patients with acquired syphilis by nonsexual contact. Demographics, clinical findings, posttreatment serology development and general laboratory data were collected. Sexual transmission was ruled out after a careful medical and psychosocial evaluation of the patient and his/her family.
RESULTS
Twenty-four patients were included in the study. Mean age at diagnosis was 4.2 years old. All of them came from overcrowded households with poor hygiene conditions. The most frequent reason for consultations was secondary syphilis skin lesions (79.2%). The psychosocial evaluation of children and their families did not reveal signs of sexual abuse in any of the cases. Seventy-eight families and their cohabitants were evaluated, 23 (29.5%) resulted positive for rapid plasma reagin and treponemal test of hemagglutination; 60.9% of the cases were asymptomatic. The symptomatic relatives showed lesions of secondary syphilis. A sustained fall on nontreponemal antibodies titer (rapid plasma reagin) was observed after treatment, becoming negative in 6/24 (25%) cases within 12 months posttreatment.
DISCUSSION
Following evaluation, it was considered that sexual abuse was unlikely. However, if examination and psychosocial evaluation do not support it, other ways of transmission must be considered. Overcrowded and poor household conditions boost the risks for nonsexual treponema transmission. An infected member of the family or a caretaker are a particular risk to an infant due to common practices such as using saliva to moisten the rubber nipples of the milk bottles or trying the food temperature using the lips before feeding the infants.
Identifiants
pubmed: 34310503
doi: 10.1097/INF.0000000000003215
pii: 00006454-202110000-00007
doi:
Substances chimiques
Antibodies, Bacterial
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
892-898Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors have no funding or conflicts of interest to disclose.
Références
Seña AC, Cox DL, Pillay A, et al. Treponema and Brachyspira, Human Host-associated Spirochetes. Manual of Clinical Microbiology. Available at: http://dx.doi.org/10.1128/9781555817381.ch60 .
Peeling R, Mabey D. Focus: Syphilis. Nat Rev Microbiol. 2. Available at: https://doi.org/10.1038/nrmicro911 . Accessed February 8, 2021.
Stoltey JE, Cohen SE. Syphilis transmission: a review of the current evidence. Sex Health. 2015;12:103–109.
Long FQ, Wang QQ, Jiang J, et al. Acquired secondary syphilis in preschool children by nonsexual close contact. Sex Transm Dis. 2012;39:588–590.
Organización Mundial de la Salud. Incidencia y prevalencia mundial de determinadas infecciones de transmisión sexual curables—2008-2012. Disponible en línea en. Available at: http://apps.who.int/iris/bitstream/10665/75181/1/9789241503839_eng.pdf . Accessed January 20, 2015
Sánchez PJ, Gutman LT. Syphilis. In: Feigin RD, Cherry-names JD, Demmler GJ, et al, eds. Textbook of Pediatric Infectious Diseases. 5th ed. Saunders, Co; 2004:1724–1743.
Raiziss GW. Rapidity With Which Spirochaeta Pallida Invades The Blood Stream. Archives of Dermatology; 1937. Available at: http://dx.doi.org/10.1001/archderm.1937.01470240093008 . Accessed February 4, 2020.
Radolf JD, Deka RK, Anand A, et al. Treponema pallidum, the syphilis spirochete: making a living as a stealth pathogen. Nat Rev Microbiol. 2016;14:744–759.
Clement ME, Okeke NL, Hicks CB. Treatment of syphilis: a systematic review. JAMA. 2014;312:1905–1917.
Radolf JD, Tramont EC, Salazar JC. Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases. Bennett JE, Dolin R, Blaser MJ, eds Elsevier Saunders; 2014:2684–2709.
Kollmann TR, Dobson S. Syphilis. In: Infectious Diseases of the Fetus and Newborn. 2011 Available at: http://dx.doi.org/10.1016/b978-1-4160-6400-8.00016-x .
Woods CR. Syphilis in children: congenital and acquired. Semin Pediatr Infect Dis. 2005;16:245–257.
Magnuson HJ, Eagle H, Fleischman R. The minimal infectious inoculum of Spirochaeta pallida (Nichols strain) and a consideration of its rate of multiplication in vivo. Am J Syph Gonorrhea Vener Dis. 1948;32:1–18.
Zhou P, Qian Y, Lu H, et al. Nonvenereal transmission of syphilis in infancy by mouth-to-mouth transfer of prechewed food. Sex Transm Dis. 2009;36:216–217.
American Academy of Pediatrics. Syphilis. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. 31st ed. American Academy of Pediatrics; 2018:773–787.
Magnuson HJ, Thomas EW, Olansky S, et al. Inoculation syphilis in human volunteers. Medicine (Baltimore). 1956;35:33–82.
Meyer GS. Occupational infection in health care. The century-old lessons from syphilis. Arch Intern Med. 1993;153:2439–2447.
Krivatkin S, Krivatkina E. P304 Secondary syphilis transmitted through non-sexual contact. Three cases description. J Eur Acad Dermatol Venereol. 1997;9:S224.
Hofmann B, Schuppe H-C, Ruzicka T, et al. Acquired syphilis II in early childhood: reappearance of syphilis brephotrophica. J Am Acad Dermatol. 1998;38:638–639.
Singh AE, Romanowski B. Syphilis: review with emphasis on clinical, epidemiologic, and some biologic features. Clin Microbiol Rev. 1999;12:187–209.
Adams JA, Kellogg ND, Farst KJ, et al. Updated guidelines for the medical assessment and care of children who may have been sexually abused. J Pediatr Adolesc Gynecol. 2016;29:81–87.
Hacienda y Finanzas. Dirección Provincial de Estadística—METODOLOGÍA NECESIDADES BÁSICAS INSATISFECHAS. Available at: http://www.estadistica.ec.gba.gov.ar/dpe/index.php/sociedad/condiciones-de-vida/necesidades-basicas-insatisfechas/177-metodologia-necesidades-basicas-insatisfechas/230-metodologia-necesidades-basicas-insatisfechas . Accessed May 19, 2020.
Thomas DD, Navab M, Haake DA, et al. Treponema pallidum invades intercellular junctions of endothelial cell monolayers. Proc Natl Acad Sci U S A. 1988;85:3608–3612.
Thomas DD, Fogelman AM, Miller JN, et al. Interactions of Treponema pallidum with endothelial cell monolayers. Eur J Epidemiol. 1989;5:15–21.
Riviere GR, Thomas DD, Cobb CM. In vitro model of Treponema pallidum invasiveness. Infect Immun. 1989;57:2267–2271.
Polypeptides of Treponema pallidum: progress toward understanding their structural, functional, and immunologic roles. Microbiol Rev. 1994;58:291.
Murrell M, Gray MS. Acquired syphilis in children. Br Med J. 1947;2:206.
Berenson AB, Chacko MR, Wiemann CM, et al. A case-control study of anatomic changes resulting from sexual abuse. Am J Obstet Gynecol. 2000;182:820–31; discussion 831.
Adams JA, Harper K, Knudson S, et al. Examination findings in legally confirmed child sexual abuse: it’s normal to be normal. Pediatrics. 1994;94:310–317.
Finkel MA, Alexander RA. Conducting the medical history. J Child Sex Abuse. 2011;20:486–504.
Garcia LN, Destito Solján A, Moroni S, et al. Congenital syphilis in Argentina: experience in a pediatric hospital. PLoS Negl Trop Dis. 2021;15:e0009010.
Lowy G. Sexually transmitted diseases in children. Pediatr Dermatol. 1992;9:329–334.
Epstein E. Extragenital syphilis in physicians. Calif Med. 1952;77:149–150.
Fuller AK. Child molestation and pedophilia. An overview for the physician. JAMA. 1989;261:602–606.
Barnard GW, Fuller AK, Robbins L: Child molesters. In: Howells JG (ed). Modern Perspectives in Psychosocial Pathology. Brunner/Mazel Inc, 1988: 23–42.
Holman KM, Wolff M, Seña AC, et al. Rapid plasma reagin titer variation in the 2 weeks after syphilis therapy. Sex Transm Dis. 2012;39:645–647.
Arando Lasagabaster M, Otero Guerra L. Syphilis. Enferm Infecc Microbiol Clin. 2019;37:398–404.