Congenital syphilis

Definition

Congenital syphilis is a severe, disabling, and often life-threatening infection seen in infants. A pregnant mother who has syphilis can spread the disease through the placenta to the unborn infant.

Alternative Names

Congenital lues; Fetal syphilis

Causes, incidence, and risk factors

Congenital syphilis is caused by the bacterium Treponema pallidum, which is passed from mother to child during fetal development or at birth. Nearly half of all children infected with syphilis while they are in the womb die shortly before or after birth.

Despite the fact that this disease can be cured with antibiotics if caught early, rising rates of syphilis among pregnant women in the United States have increased the number of infants born with congenital syphilis.

Symptoms

Symptoms in newborns may include:

• Failure to gain weight or failure to thrive
• Fever
• Irritability
• No bridge to nose (saddle nose)
• Early rash -- small blisters on the palms and soles
• Later rash -- copper-colored, flat or bumpy rash on the face, palms, and soles
• Rash of the mouth, genitalia, and anus
• Watery discharge from the nose

Symptoms in older infants and young children may include:

• Abnormal notched and peg-shaped teeth, called Hutchinson teeth
• Bone pain
• Blindness
• Clouding of the cornea
• Decreased hearing or deafness
• Gray, mucus-like patches on the anus and outer vagina
• Joint swelling
• Refusal to move a painful arm or leg
• Saber shins (bone problem of the lower leg)
• Scarring of the skin around the mouth, genitalia, and anus

Signs and tests

If the disorder is suspected at the time of birth, the placenta will be examined for signs of syphilis. A physical examination of the infant may show signs of liver and spleen swelling and bone inflammation.

A routine blood test for syphilis is done during pregnancy. The mother may receive the following blood tests:

• Fluorescent treponemal antibody absorbed test (FTA-ABS)
• Rapid plasma reagin (RPR)
• Venereal disease research laboratory test (VDRL)

An infant or child may have the following tests:

• Bone x-ray
• Eye examination
• Lumbar puncture
• Dark-field examination to better detect syphilis-related bacteria under a microscope

Treatment

Penicillin is used to treat all forms of syphilis.

Expectations (prognosis)

Many infants who were infected early in the pregnancy are stillborn. Treatment of the expectant mother lowers the risk of congenital syphilis in the infant. Babies who become infected when passing through the birth canal have a better outlook.

Complications

• Blindness
• Deafness
• Deformity of the face
• Neurological problems

Calling your health care provider

Call your health care provider if your baby has signs or symptoms of this condition.

If you think that you may have syphilis and are pregnant (or anticipate becoming pregnant), call your health care provider immediately.

Prevention

Safer sexual practices may help prevent syphilis. If you suspect you have a sexually transmitted disease such as syphilis, seek medical attention immediately to avoid complications like infecting your baby during pregnancy or birth.

Prenatal care is very important. A routine blood test for syphilis is done during pregnancy. This identifies infected mothers and allows them to be treated to reduce the risks to the infant and themselves. Infants born to infected mothers who received proper penicillin treatment during pregnancy are at minimal risk for congenital syphilis.

References

Wolff T, Shelton E, Sessions C, Miler T. Screening for syphilis infection in pregnant women: Evidence for the U.S. Preventive Services Task Force Reaffirmation Recommendation Statement. Ann Intern Med. 2009;150:710-716.

Workowski KA, Berman SM. Centers for Disease Control and Prevention. Congenital syphilis. Sexually transmitted diseases treatment guidelines 2006. MMWR Morb Mortal Wkly Rep. 2006;55(RR-11):30-33.

Azimi P. Syphilis (Treponema pallidum). In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 215.