Syphilis is a sexually transmitted disease that can harm adults and unborn babies. It can cause neurological, cardiovascular, and dermatological problems in adults. It can also infect babies during pregnancy or birth. This is called congenital syphilis, and it is a preventable and curable disease. However, it still affects thousands of people each year in the Americas.
What is congenital syphilis?
Congenital syphilis happens when a baby gets syphilis from their mother. The baby can get infected at any time during the pregnancy, but the risk is higher in the second half of the pregnancy. Congenital means that the infection exists at birth.
What are the symptoms and complications of congenital syphilis?
Many babies with congenital syphilis have no symptoms at birth. The infection may remain hidden for years. However, some babies may have signs such as:
- Rash on the palms and soles, or around the nose and mouth
- Runny and congested nose (snuffles)
- Fever, irritability, and failure to thrive
- Enlarged liver and spleen
- Swollen lymph nodes
- Warty bumps on the genitals
- Jaundice, anemia, or low platelets
- Meningitis, seizures, or hydrocephalus
- Deafness or blindness
If not treated early, congenital syphilis can cause more damage to the baby’s organs, bones, brain, and nerves. Some of the long-term complications include:
- Skeletal deformities of the nose, lower legs, forehead, collarbone, jaw, and cheekbone
- Dental abnormalities such as notched or peg-shaped teeth
- Inflammation of the cornea (interstitial keratitis)
- Intellectual disability or learning difficulties
- Hydrocephalus (excess fluid in the brain)
- Paresis (weakness or paralysis) or tabes (loss of coordination)
- Optic atrophy (damage to the optic nerve)
Congenital syphilis can also cause miscarriage, stillbirth, premature birth, or death of the newborn. The table below shows the number of syphilitic stillbirths and congenital syphilis-related infant deaths reported in the Americas in 2020.
| Type of death | Number |
|---|---|
| Syphilitic stillbirths | 94 |
| Congenital syphilis-related infant deaths | 34 |
How is congenital syphilis diagnosed and treated?
The best way to prevent congenital syphilis is to screen all pregnant women for syphilis at least three times during prenatal care: at the first visit, before week 20, and in the third trimester. If a pregnant woman tests positive for syphilis, she should be treated immediately with penicillin. Penicillin is safe and effective for both mother and baby.
The baby should also be tested for syphilis at birth and treated with penicillin if:
- The mother has untreated or inadequately treated syphilis
- The mother has a positive test result after 28 weeks of pregnancy
- The mother’s treatment status is unknown
- The baby has signs or symptoms of congenital syphilis
The baby should be followed up with blood tests and physical exams until the infection is cured. If the baby has complications from congenital syphilis, they may need additional treatments or interventions depending on their condition.
How can we eliminate congenital syphilis?
Despite being a preventable and curable disease, congenital syphilis remains a public health problem in many countries in the Americas. According to PAHO (Pan American Health Organization), an estimated 4.6 million people have syphilis in the region. In 2020, countries reported 29,147 cases of congenital syphilis; preliminary figures for 2021 indicate more than 30,000 cases.
The main factors that contribute to congenital syphilis are:
- Lack of access to quality prenatal care and syphilis testing for pregnant women
- Lack of adequate treatment for pregnant women with syphilis and their partners
- Late diagnosis or seroconversion (development of antibodies) during pregnancy
- Increasing rates of primary and secondary syphilis in the general population
- Social determinants such as poverty, stigma, discrimination, gender inequality, and substance use
To eliminate congenital syphilis as a public health threat by 2030, PAHO recommends that countries implement these strategies:
- Strengthen surveillance systems to monitor trends and identify gaps in prevention and care
- Integrate screening and treatment for syphilis, HIV, hepatitis B, and Chagas disease in prenatal care
- Ensure availability and accessibility of penicillin and rapid diagnostic tests
- Promote sexual and reproductive health education and services
- Engage communities and health workers to raise awareness and reduce stigma
- Address social and structural barriers that affect vulnerable populations
Congenital syphilis is a silent but deadly threat to newborns that can be eliminated with effective public health measures. By working together, we can protect the health and well-being of mothers and babies from this ancient disease.
