About Congenital Syphilis

Congenital syphilis occurs when a woman who is infected with syphilis passes the disease to her unborn child. The rate of transmission is quite high; 60 to 80 percent of babies born to mothers with syphilis are infected. Transmission usually takes place during pregnancy, when the spirochete that causes syphilis is passed through the placenta, but in some cases the infection happens during childbirth.

Time Frame

Congenital syphilis progresses similarly to syphilis infection in adults, although the stages of the disease are less well-defined. Children with congenital syphilis who do not receive prompt treatment usually go through early, latent and late manifestations of the disease. The early stage occurs between birth and the first few months of life, followed by a latent stage. Late congenital syphilis typically begins when the child is at least 2 years old.

Effects

Early congenital syphilis causes a rash similar to that of secondary syphilis in adults. The rash may consist of blisters or copper-colored bumps and is usually most severe on the genitals, nose and mouth. Infants with early congenital syphilis often have a bloody nasal discharge and in some cases may develop nervous system problems including seizures, paralysis, hydrocephalus and learning disabilities. The latent stage of syphilis that follows has no symptoms, and the infant usually appears to have recovered. Late congenital syphilis resembles tertiary syphilis in adults, although neurological complications are less frequent. Lesions of the eye and blindness are common complications. Growths and ulcers may develop, causing damage to the bones, particularly facial bones. Teeth are often damaged by congenital syphilis and have a characteristic notched appearance.

Identification

Diagnosis is usually made when routine maternal screening tests detect syphilis in the mother. In some cases, congenital syphilis is not suspected until the infant displays symptoms of the condition. Tests are then performed on both the mother and baby to measure levels of antibodies. These tests often give false positive results, so more specific testing may be required to confirm the diagnosis.

Prevention/Solution

If syphilis is detected early in pregnancy, infection of the fetus can nearly always be prevented by treating the mother with antibiotic injections. The treatment of syphilis sometimes causes a Jarisch-Herxheimer reaction, which can cause miscarriage in early pregnancy. Despite this risk, pregnant women who have syphilis nearly always receive treatment, since the chance of stillbirth without treatment is much higher. Infants with congenital syphilis are given antibiotic injections, usually over a period of 10 days. Although this is curative, permanent damage caused by syphilis infection cannot be reversed.

Warning

40 percent of pregnancies in women who are infected with syphilis will end in stillbirth. Between 60 and 80 percent of the remaining infants will be born with congenital syphilis. Many of these children will have permanent disabilities or will be disfigured by the disease. Congenital syphilis is almost always preventable. Because syphilis testing is routinely performed during pregnancy, it is extremely rare when women receive prenatal care starting early in pregnancy.

Resources

• Merck Manual: Congenital Syphilis
• New York Times Health: Congenital Syphilis