Congenital syphilis

https://doi.org/10.1053/j.semperi.2018.02.005Get rights and content

Abstract

Congenital syphilis remains a major public health problem worldwide, and its incidence is increasing in the United States. This review highlights the ongoing problem of this preventable infection, and discusses vertical transmission and clinical manifestations while providing a practical algorithm for the evaluation and management of infants born to mothers with reactive serologic tests for syphilis. Every case of congenital syphilis must be seen as a failure of our public health system to provide optimal prenatal care to pregnant women, as congenital syphilis can be prevented by early and repeated prenatal serologic screening of mothers and penicillin treatment of infected women, their sexual partners, and their newborn infants.

Section snippets

Transmission

Syphilis is transmitted to the fetus transplacentally following maternal spirochetemia, although transmission to the newborn could occur intrapartum by contact with maternal genital lesion(s). Intrauterine transmission is supported by the isolation of the organism from umbilical cord blood and amniotic fluid by rabbit infectivity testing.10, 11, 12 The isolation of T. pallidum from as many as 74% of amniotic fluid specimens obtained from women with early syphilis also suggests that the organism

Clinical manifestations

Syphilis during pregnancy is associated with premature delivery, spontaneous abortion, stillbirth, nonimmune hydrops, perinatal death, and two characteristic syndromes of clinical disease, early and late congenital syphilis.21 Moreover, the placenta of infants with congenital syphilis often is large, thick, and pale. Histopathologic features include necrotizing funisitis (“barber's pole” appearance), villous enlargement, and acute villitis.22 Placental and umbilical cord histopathology should

Diagnosis and management

The diagnosis of congenital syphilis is established by the observation of spirochetes in body fluids or tissue and suggested by serologic test results. T. pallidum may be identified by dark field microscopy, polymerase chain reaction (PCR) testing, and fluorescent antibody or silver staining of mucocutaneous lesions, nasal discharge, vesicular fluid, amniotic fluid, placenta, umbilical cord, or tissue obtained at autopsy. In research laboratories, the diagnosis also can be established by

Treatment

Penicillin is the only known effective antimicrobial agent for prevention of vertical transmission of syphilis and treatment of fetal infection and congenital syphilis.34, 36 Pregnant women with syphilis should receive the penicillin regimen appropriate for the stage of infection.34 Pregnant women who have a history of penicillin allergy should be desensitized and treated with penicillin.37

The decision to treat an infant for congenital syphilis is based on the clinical presentation, previous

Follow-up

Although data are lacking on neurodevelopmental outcomes of infants with congenital syphilis, the majority of these infants who are treated in early infancy do well without any long-term complications due to syphilis. Infants with reactive serologic test results or born to mothers who were seroreactive at delivery should have serial quantitative nontreponemal tests performed every 2–3 months until preferably the test becomes nonreactive or the titer has decreased fourfold. In infants with

Prevention

Congenital syphilis is effectively prevented by prenatal serologic screening of mothers and penicillin treatment of infected women, their sexual partners, and their newborn infants.47 All pregnant women should have a serologic test for syphilis performed at the first prenatal visit in the first trimester, and in high risk areas, again at 28–32 weeks’ gestation and delivery.34 Serologic screening tests should be performed on mothers and not on infants, because the infant may have a nonreactive

Financial disclosure

The authors have no financial relationships relevant to this article to disclose.

Funding source

No funding was required for this manuscript.

Potential conflicts of interest

The authors have no conflicts of interest relevant to this article to disclose.

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