1. C ONGENITAL S YPHILIS

3. Mom: 21yrs, Am. Ind., Non-Hisp  No regular prenatal care o 1 st visit 11-15-13 o Last visit 1-29-14  4-14-14 presents at small hospital for L& D  Dr. notices labial sore, and questions patient  Patient states that the sore “had been there a while” and it wasn’t too painful. Labs Ordered and Results:  11-15-13 – RPR was non reactive  11-15-13 – Gonorrhea+  11-15-13 – Chlamydia and HIV –  4-14-14 – RPR 1:64, TPPA reactive  4-14-14 – CT/GC negative Treatment:  11-15-13 250mg Rocephin, 1gm Zith  4-15-14 2.4 mU Bicillin Congenital Case #1

4.  Born 4-14-14  Healthy weight and length  No congenital deformities  No chancres, rash, or mucosal S/S  4-15-14 unresolved fever  Baby was transferred to NICU at a larger hospital Labs Ordered and Results:  4-15-14 Lumbar puncture – WBC, CBC, protein, glucose all within normal limits. RPR and TPPA non reactive.  4-15-14 Blood draw (non-umbilical) RPR 1:8 TPPA reactive  4-15-14 Long Bone Survey – Normal Treatment:  4-16-14 IV Penicillin 150,000 units/kg/day for 10 days

5. Congenital Case #2 Mom: 16yrs, Am. Ind., Non-Hisp  No early prenatal care  Regular 3 rd trimester care  No vaginal exams  5-28-14 presents for 38 week visit. Labs Ordered and Results:  8-8-13 Chlamydia +, GC –  11-20-13 RPR Non-reactive  11-20-13 Gonorrhea +  11-20-13 Chlamydia and HIV –  5-28-14 RPR 1:256, TPPA reactive Treatment:  8-15-13 1gm Zith  11-20-13 250 mg Rocephin and 1 gm Zith  6-4-14 2.4 mU Bicillin  Dr. refers mom for C- section and NICU for baby.  Vaginal exam 6-6-14, prior to C-section, healing lesion seen.

6.  Born 6-5-14  Healthy weight and length  No congenital deformities  No chancres, rash, or mucosal S/S Labs Ordered and Results:  6-6-14 Lumbar puncture – WBC, CBC, protein, glucose all within normal limits. RPR and TPPA non reactive.  6-6-14 Blood draw (non-umbilical) RPR 1:8 TPPA reactive  6-6-14 Long Bone Survey - Normal Treatment: 6-6-14 IV Penicillin 150,000 units/kg/day for 10 days

7. Congenital Case #3 Mom: 25yrs, White, Non-Hisp  Regular prenatal appointments  No current S/S  No recollection of past S/S  3-12-14 presents for 24 week care Labs Ordered and Results:  3-12-14 RPR 1:64, no TPPA done  3-25-14 RPR 1:128, TPPA reactive  5-12-14 RPR 1:64, TPPA reactive  8-4-14 RPR 1:64, TPPA reactive  Additional labs pending Treatment:  3-24-14 2.4 mU Bicillin  4-7-14 2.4 mU Bicillin  5-21-14 2.4 mU Bicillin Concerns:  Re-infection  Treatment failure

8.  Born 6-5-14 via C-section  Healthy weight and length  No congenital deformities  No chancres, rash, or mucosal S/S Labs Ordered and Results:  7-22-14 Blood draw (non-umbilical) RPR 1:16, TPPA reactive  7-23-14 Lumbar puncture -- WBC, CBC, protein, glucose all within normal limits. RPR and TPPA non reactive.  7-23-14 Long Bone Survey – consistent with Congenital Syphilis Treatment:  7-23-14 IV Penicillin 200,000 units/kg/day for 10 days

9. (Suspect) Congenital Case #4 Mom: 22yrs, Am. Ind., Non-Hisp  7-28-14, 1 st prenatal appointment at 12 weeks  “Kissing” lesions & alopecia Labs Ordered & Results:  7-28-14 RPR 1:128, TPPA Reactive  7-28-14 CT +, GC +, HIV - Treatment:  8-1-14 250mg Rocephin, 1gm Zith, 2.4 mU Bicillin Fetus:  No heartbeat detected on 8-11-14

10. Is this the end of our Congenital Cases? Amanda Gill M.S. South Dakota Dept. of Health STD Program Manager amanda.gill@state.sd.us 605-773-4794 605-280-4793