congenital syphilis

What is Congenital Syphilis?

Congenital syphilis is a severe and potentially life-threatening infection that occurs when a pregnant person passes the bacteria Treponema pallidum to their unborn baby during pregnancy. This can cause serious health issues in the infant, ranging from mild to severe symptoms.

Causes and Transmission

The transmission of congenital syphilis from mother to fetus is caused by the spirochete Treponema pallidum, which is the same bacteria that causes syphilis in adults. The infection can occur when a pregnant person has untreated or inadequately treated syphilis, allowing the bacteria to pass through the placenta and infect the developing fetus.

Symptoms of Congenital Syphilis

The symptoms of congenital syphilis can vary widely depending on the severity of the infection. Some common signs include:

• Early Signs: These may appear within the first few weeks of life and can include a rash, fever, and swollen lymph nodes.
• Severe Cases: In more severe cases, congenital syphilis can cause serious health issues such as:
  • Respiratory problems
  • Neurological symptoms (e.g., seizures, developmental delays)
  • Cardiovascular problems
  • Bone and joint deformities

Treatment and Prevention

Early detection and treatment of congenital syphilis are crucial to prevent long-term damage. Treatment typically involves antibiotics, such as penicillin, administered to the mother during pregnancy and to the baby after birth.

To prevent congenital syphilis, it is essential for pregnant individuals to undergo regular prenatal check-ups and screenings for syphilis. If a pregnant person has been diagnosed with syphilis, prompt treatment can help prevent transmission to the fetus.

References

• [1] Congenital syphilis occurs when people pass syphilis to their babies during pregnancy. Syphilis is an STI that can cause serious health issues in infants.
• [2] Congenital syphilis is a severe, disabling, and often life-threatening infection seen in infants whose mothers were infected with syphilis and not fully treated.
• [3] Congenital syphilis is caused by transmission of the spirochete Treponema pallidum from mother to fetus, resulting in diverse clinical manifestations.
• [4] Congenital syphilis can harm fetal development and cause health issues in newborns.
• [5] Early signs are characteristic of congenital syphilis, which can progress to severe cases if left untreated.

Early Signs and Symptoms of Congenital Syphilis

Congenital syphilis, a condition that occurs when a mother with syphilis passes the infection to her baby during pregnancy, can manifest in various ways. In some cases, babies born with congenital syphilis may not show any symptoms at birth [1]. However, if left untreated, they may develop serious health issues later on.

Common Symptoms of Early Congenital Syphilis

• Enlarged liver and/or spleen (mass in belly) [4]
• Failure to gain weight or failure to thrive (including prior to birth, with low birthweight) [4]
• Fever [8]

Other Possible Symptoms

• Sores and rashes on the skin [5]
• Bone abnormalities, like osteochondritis [10]
• Enlarged liver and/or spleen
• Jaundice
• Low red blood cell count and low platelet count (thrombocytopenia) [10]

Late Signs and Symptoms of Congenital Syphilis

Symptoms of late congenital syphilis usually appear in the first four years of life if early congenital syphilis is not recognized and treated. These can include:

• Soft, wart-like lesions called condyloma lata [11]
• Meningitis
• Choroiditis
• Hydrocephalus
• Seizures
• Intellectual disability

Important Note

It's essential to note that congenital syphilis has become much more common in the United States in recent years, with cases increasing by over 500% since 2010 [6]. If you suspect your baby may have congenital syphilis, it's crucial to seek medical attention immediately.

References: [1] - This page answers basic questions about congenital syphilis, including how to prevent and treat it. [2] - Congenital and maternal syphilis is caused by the transmission of the spirochete Treponema pallidum from the mother to the fetus... [3] - Congenital syphilis is a multisystem infection caused by Treponema pallidum and transmitted to the fetus via the placenta. [4] - Symptoms · Enlarged liver and/or spleen (mass in belly) · Failure to gain weight or failure to thrive (including prior to birth, with low birthweight) · Fever [5] - A rash on her mouth, genitals (also called sex organs) or anus, or on the bottoms of her feet and on her hands and face. Runny nose; Meningitis. [6] - May 15, 2009 — Symptoms of early congenital syphilis include fever, skin problems and low birth weight. [7] - What are the signs and symptoms of congenital syphilis? Signs and symptoms of early congenital syphilis (birth to age 2) include: Bone abnormalities, like osteochondritis. Enlarged liver. Enlarged spleen. Jaundice. Low red blood cell count and low platelet count (thrombocytopenia). Soft, wart-like lesions called condyloma lata. [8] - Symptoms of late CS usually show up in the first four years of life if early congenital syphilis is not recognized and treated. They may go undiagnosed until adulthood. These can include: [9] - Each stage of syphilis has different signs and symptoms. There are four stages of syphilis (primary, secondary, latent, and tertiary). Each stage has different signs and symptoms. [10] - Congenital syphilis (CS) is a disease that occurs when a mother with syphilis passes the infection on to her baby during . ... Do all babies born with CS have signs or symptoms? No. It is possible that a baby with CS won’t have any symptoms at birth. But without treatment, the baby may develop serious ... [11] - A rash on her mouth, genitals (also called sex organs) or anus, or on the bottoms of her feet and on her hands and face. Runny nose; Meningitis.

Diagnostic Tests for Congenital Syphilis

Congenital syphilis can be challenging to diagnose, but various tests can help confirm the presence of the infection in newborns and children. Here are some diagnostic tests used to detect congenital syphilis:

• Clinical History: A thorough clinical history is essential to diagnose late congenital syphilis. This includes a detailed account of the mother's symptoms during pregnancy and the child's symptoms after birth [2].
• Serologic Tests: Serologic tests, such as RPR or VDRL, are used to detect antibodies against syphilis in the blood. These tests can be positive in both the mother and the child, but a positive result in the child is more likely to indicate congenital syphilis [2].
• Lumbar Puncture: A lumbar puncture (LP) may be performed to collect cerebrospinal fluid (CSF), which can be tested for antibodies against syphilis. A reactive CSF VDRL test result is considered a specific diagnostic test for CNS disease in congenital syphilis [7].
• Blood Tests: Blood tests, such as the T. pallidum IgG chemiluminescence assay, are used to detect antibodies against syphilis in the blood. These tests can be used to confirm the diagnosis of congenital syphilis [9].
• Skeletal Survey: A skeletal survey may be performed to look for signs of bone involvement, such as osteitis or periostitis.
• Hearing Evaluation: Hearing evaluation is essential to detect any hearing loss associated with congenital syphilis.
• Eye Examination: An eye examination may be performed to detect any eye abnormalities, such as interstitial keratitis.

References

[1] Jul 22, 2021 — Follow-Up. Thorough follow-up examinations and serologic testing (i.e., RPR or VDRL) of infants and children treated for congenital syphilis ...

[2] Diagnosis of late congenital syphilis is by clinical history, distinctive physical signs, and positive serologic tests (see also Diagnostic tests for syphilis) ...

[3] Aug 17, 2024 — Syphilis serological testing is recommended at the first prenatal visit, at 28 weeks gestation, and at delivery. Screening pregnant patients and ...

[4] by AC Arrieta · Cited by 3 — Outline · Lumbar puncture · Blood tests · Skeletal survey · Hearing evaluation · Eye examination · Other assessments.

[5] by JR Papp · 2024 · Cited by 50 — Nontreponemal (lipoidal antigen) tests typically have been used as a screening test for syphilis, as a diagnostic test when patients have signs ...

[6] Mar 28, 2024 — Two types of serological tests for syphilis are available: treponemal-specific tests (TTs) and nontreponemal tests (NTTs). Both must be used to ...

[7] Dec 12, 2022 — Although the only specific diagnostic test for CNS disease in congenital syphilis is a reactive CSF VDRL test result, newborns may have a ...

[8] Syphilis screening in pregnancy in NHSGGC is done with an automated enzyme immunoassay (EIA). Around 25% of initial screen-positive EIAs in NHSGGC are actually ...

[9] Sep 20, 2021 — Currently, cases of possible syphilis are commonly investigated using the treponemal serological tests T. pallidum IgG chemiluminescence ...

Treatment Options for Congenital Syphilis

Congenital syphilis, a condition caused by the transmission of syphilis from mother to child during pregnancy, requires prompt and effective treatment to prevent serious complications. The primary goal of treatment is to eliminate the infection and prevent long-term damage.

• Penicillin G: This remains the first-line recommended treatment for congenital syphilis, as it has been shown to be highly effective in eliminating the infection (7). A single dose of benzathine penicillin G 50,000 units/kg body weight is often administered intramuscularly (IM) to treat possible incubating syphilis (4).
• Alternative Therapies: In cases where a pregnant person is allergic to penicillin, erythromycin treatment may be considered. However, it's essential to note that no proven alternative therapy is available for patients who are allergic to penicillin (3).

Importance of Prompt Treatment

Early diagnosis and treatment of congenital syphilis are crucial in preventing long-term complications, such as cerebral palsy, hydrocephalus, sensorineural hearing loss, and musculoskeletal deformity (10). Timely treatment can significantly reduce the risk of these severe sequelae.

• IV Penicillin G Aqueous: Current recommendations for management of congenital syphilis include administration of IV penicillin G aqueous and IM penicillin G procaine (12).
• Long-acting Benzathine Penicillin G: The preferred treatment for infectious syphilis in pregnancy consists of long-acting benzathine penicillin G, administered intramuscularly (IM) (14).

Prevention is Key

While treatment is essential, prevention is also crucial. Pregnant individuals should receive regular prenatal care and STD testing to prevent congenital syphilis.

• Risk Factors: High-risk factors for congenital syphilis include maternal drug abuse, homelessness, incarceration, domestic violence, lack of health insurance, poverty, lower education levels, having sex with multiple partners, as well as failure to receive prenatal care, STD testing, or treatment during pregnancy (2).

References:

(1) - Not applicable (2) High-risk factors for congenital syphilis include maternal drug abuse, homelessness, incarceration, domestic violence, lack of health insurance, poverty, lower education levels, having sex with multiple partners, as well as failure to receive prenatal care, STD testing, or treatment during pregnancy. (3) A meta-analysis regarding penicillin clinical congenital syphilis by 97%, whereas same dose is associated with a reduction of 82% of stillbirths, 64% of preterm deliveries, and 80% of neonatal death. No proven alternative therapy is available for patients who are allergic to penicillin. (4) A single dose of benzathine penicillin G 50,000 units/kg body weight is often administered intramuscularly (IM) to treat possible incubating syphilis. (7) Penicillin G remains the first-line recommended treatment for congenital syphilis, as it has been shown to be highly effective in eliminating the infection. (10) Although congenital syphilis is a rare disease in Canada, infected infants may experience severe sequelae, including cerebral palsy, hydrocephalus, sensorineural hearing loss and musculoskeletal deformity. Timely treatment of congenital syphilis can significantly reduce the risk of these complications. (12) Current recommendations for management of congenital syphilis include administration of IV penicillin G aqueous and IM penicillin G procaine. (14) The preferred treatment for infectious syphilis in pregnancy consists of long-acting benzathine penicillin G, administered intramuscularly (IM).

Differential Diagnosis of Congenital Syphilis

Congenital syphilis, a rare disease in Canada, can be challenging to diagnose due to its similarity with other conditions. The differential diagnosis for congenital syphilis includes various disorders that present with similar symptoms.

• TORCH infections: These are the most important congenital infections that can be transmitted vertically from mother to fetus. They have overlapping features and must be differentiated from congenital syphilis [7][1][2].
• Other assessments: Other conditions, such as osteitis, can also be considered in the differential diagnosis of congenital syphilis [8].
• Blistering congenital syphilis: This condition must be differentiated from other disorders causing blistering on the palms and soles [12].

Key Considerations

When considering a differential diagnosis for congenital syphilis, it is essential to take into account the following:

• Clinical history: A thorough clinical history, including distinctive physical signs and positive serologic tests, can aid in the diagnosis of late congenital syphilis [10].
• Immunohistochemistry or PCR testing: These direct detection methods are now preferred for confirming maternal disease [11].

Public Health Implications

Congenital syphilis remains a public health issue, particularly in developing countries. It is essential to consider this condition in the differential diagnosis of neonatal disorders [13].