Congenital Syphilis Resurgences and Penicillin Shortage
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SCIENTIFIC LETTER
Congenital Syphilis Resurgences and Penicillin Shortage Ashish Agarwal 1 & Jogender Kumar 1 Received: 14 February 2020 / Accepted: 13 April 2020 # Dr. K C Chaudhuri Foundation 2020
To the Editor: Congenital syphilis is a transplacentally acquired infection caused by Treponema pallidum. Timely antenatal screening and adequate treatment with Benzathine Penicillin G (BPG) can prevent mother-to-child transmission. We present a case of syphilis where the mother-baby dyad faced penicillin shortage. A 2.4 kg, appropriate for gestational age boy was born at 36 + 3 wk to a mother who was not screened for syphilis in the first trimester despite regular antenatal visits. At 33 wk she visited another obstetrician and was diagnosed as VDRL-reactive. Amidst non-availability of BPG in the hospital/market, she did not get any treatment for one week. After great difficulty BPG was arranged and she received 3 doses (weekly) assuming the unknown stage of syphilis. Baby was delivered within two days of the last dose. On evaluation, he had reactive cerebrospinal fluid (CSF) VDRL and was referred to us given the non-availability of penicillin at that place. There were no clinical stigmata of congenital syphilis. Complete blood count, liver function test, ophthalmology evaluation, cranial ultrasound, and bone radiograph were normal. Blood VDRL titer was >1:16. Lumbar puncture revealed meningitis (cells-30 lymphocytes, sugar-36 mg/dl, protein178 mg/dl, culture-sterile) [1]. Considering a proven/ highly probable case, treatment with aqueous crystalline/ procaine penicillin G is recommended [1]. Unfortunately, both were unavailable with us or at nearby hospitals/open market, so ceftriaxone was started. Three days later we could get aqueous penicillin, which was given for 10 d and the baby was discharged. Further follow-up will be done as per the guidelines [1]. Congenital syphilis, once thought to be near-elimination, is facing recent resurgence across the globe [2, 3].
* Jogender Kumar [email protected] 1
Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
Lack of routine antenatal testing, shortage of the penicillin, and lack of training among the healthcare providers are responsible for it [3]. BPG is the only recommended antibiotic to prevent mother-to-childtransmission of syphilis during pregnancy. Recently, there has been an acute shortage of penicillin worldwide, including India [4]. This shortage is thought to be due to the lack of profit for the manufacturers. BPG is an off-patent drug and is included in the “essential-medicines” list [5]. This led to a significant reduction in the prices (INR 9 per unit), hence profit to the companies. In our case, if the mother would have been screened in the first trimester or she would have got BPG at the time of diagnosis, the baby might not have been infected. All pregnant women should be screened for syphilis at the first antenatal visit and for the women at highrisk for infection, serologic testing should
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