Congenital Syphilis

Congenital Syphilis

Sexual Health
Diseases & Conditions
Contributed byMaulik P. Purohit MD MPHMay 25, 2020

What are the other Names for this Condition? (Also known as/Synonyms)

  • Congenital Lues
  • Fetal Syphilis
  • Hutchinson's Teeth

What is Congenital Syphilis? (Definition/Background Information)

  • Syphilis is a very common infectious disease caused by the bacterium Treponema pallidum. Syphilis is generally transmitted through sexual contact. It has the potential to develop into a serious medical issue with long-term complications resulting in death, if treatment is delayed or is lacking
  • A pregnant woman affected by Syphilis can transmit the infection to her child through the placenta, while the baby is still in the womb. This causes Congenital Syphilis, which is a life-threatening illness, if it remains undetected, or early management of the condition is not undertaken
  • In a baby, Congenital Syphilis develops a few weeks (or months) after birth and causes severe neurological impairment, bone and tooth problems, and skin conditions
  • The universal treatment for this condition (at all stages) is by using the drug penicillin, which can bring about a complete recovery. However, timely recognition of the condition is necessary, and treatment should be commenced at the earliest

Who gets Congenital Syphilis? (Age and Sex Distribution)

  • Women who are infected with Syphilis (and are untreated), before or during pregnancy, have an extremely high risk of transmitting it to their unborn offspring
  • No gender preference or racial predilection is observed, among the affected newborns
  • However, in certain geographical regions with lower socio-economic standards and insufficient access to proper healthcare; it is found that the general incidence of sexually transmitted diseases (STDs), including Syphilis is higher

What are the Risk Factors for Congenital Syphilis? (Predisposing Factors)

Untreated pregnant women with syphilis, have a very high risk (90% chance) of passing on the infectious bacteria to the baby in the womb. This is the only risk factor. The individual may have contracted the infection as early as 4 years prior to pregnancy.

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Congenital Syphilis? (Etiology)

Syphilis is caused by the bacterium Treponema pallidum. Congenital transmission of syphilitic infection that takes place inside the uterus, from a mother to the infant child, causes Congenital Syphilis. This can happen any time in pregnancy or even during delivery. Untreated Syphilis can affect the mother and child lifelong. There are three progressive stages of Syphilis:

  • Primary stage: After the initial attack, the bacterium spreads all over the body using the blood vessels and lymphatic system and multiplies rapidly. Primary lesions form within a few hours after infection. These contain large quantities of Treponema bacteria
  • Secondary stage: The bacteria invade tissues, cerebrospinal fluid, skin, and mucus membranes. It causes inflammatory rashes on the body (secondary lesions), within 6-12 weeks. This continues till a stage of dormancy is reached; after which a relapse or remission takes place (within a year)
  • Tertiary stage: The central nervous system is affected; several vital organs (such as the heart and liver) may develop infections, and nerve cells are destroyed resulting in neurological symptoms

What are the Signs and Symptoms of Congenital Syphilis?

Newborns with Congenital Syphilis may not present any signs or symptoms at birth. But, these can develop quickly, necessitating prompt treatment. The disorder progresses in stages. Newborns are often born during the secondary stage of the disorder, while older infants move onto the tertiary/final stage. Both these stages present different set of symptoms. The signs and symptoms include:

In newborns and young children (less than 2 years):

  • Lack of, or delay in progressive growth of the baby (failure to thrive)
  • Lung infection (pneumonia)
  • Running nose with watery discharge, fever
  • Skin rashes, on the hand palms and feet soles that change to copper-color; lesions around the genitals, anus, and mouth
  • Irritability, feeding problems

In older children (over 2 years):

  • Presence of notched teeth (having serrated edges) called Hutchinson’s teeth. Normally, the upper incisors are affected
  • Upper and lower limb problems; pain in the bones with joint inflammations (child refuses to move hands or legs, affected by pain)
  • Neurological abnormalities
  • Hearing loss (partial or complete)
  • Vision problems (blindness, corneal clouding)
  • Skin patches (scarring) around genitals, anus, and mouth; mucus formation seen

How is Congenital Syphilis Diagnosed?

Diagnostic tests may be performed on the mother (while she is pregnant), or on the child after delivery, to detect Congenital Syphilis. The tests include:

  • Prenatal screening on pregnant women, which includes a blood test (to screen for sexually transmitted infections, like syphilis)
  • In older infants: Physical exam, blood test, x-ray of the bones/joints, exam of cerebrospinal fluid (lumbar puncture), ophthalmological evaluation

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis

What are the possible Complications of Congenital Syphilis?

Complications due to Congenital Syphilis include:

  • Severe neurological abnormalities
  • Complete loss of vision, hearing
  • Facial deformity
  • Failure to thrive, resulting in short stature
  • Bone and joint abnormalities

How is Congenital Syphilis Treated?

Prompt, early diagnosis and appropriate treatment (before birth of child, or immediately  following birth) is the key to speedy recovery from Congenital Syphilis:

  • All manifestations of syphilis are treated using the antibiotic drug penicillin; whether it is a pregnant woman, newborn baby, or an older infant. Worldwide, penicillin is a cheap and easily available drug that is also simple to administer
  • If the individual is allergic to penicillin, then it is given in very small dosages and in a controlled manner, until the body gets sensitized (accustomed) to the drug

How can Congenital Syphilis be Prevented?

  • Congenital Syphilis is an infectious disorder that is transmitted from a mother to the child. If the mother is not affected with the disease, then the child will not contract it. Thus, it is a preventable and curable disease
  • Pregnant women with untreated Syphilis can infect the baby in the womb. Hence, it is recommended that all pregnant women should undergo screening tests for Syphilis

Most healthcare providers screen pregnant women regularly for syphilis. However, the onus is on all women planning for a child, to ensure that they are generally well-informed (either by their healthcare providers or public health authorities) of the sexually transmitted syphilitic infection.

They have to be also aware of the preventive measures and precautions to be taken, prior to conceiving a child, which include:

  • Avoidance of multiple sex partners
  • Practice of safe sex (use of condoms that prevent entry of the syphilis bacteria)
  • Excessive craving for drugs and alcohol, may lead to unsafe practices such as ‘sex for drugs’
  • Have a monogamous partner, if you are planning for a child
  • If you are frequently sexually active with multiple partners; then regular screening for sexually transmitted diseases is essential
  • It is best not to get pregnant, if you have had a recent infection of syphilis. It is better to consult a gynecologist under such circumstances, to help you plan your child

What is the Prognosis of Congenital Syphilis? (Outcomes/Resolutions)

  • Congenital Syphilis in infants can be completely treated, if infection has taken place just before, or during delivery of the child. An early diagnosis and proper management of the condition is very crucial. A full recovery is possible and the outcome is excellent in such cases
  • Expectant mothers, who are treated for Syphilis, drastically reduce the vulnerability of their unborn child to contract Syphilis
  • The timing of infection of the fetus is important. If the mother transmits Syphilis early in pregnancy to the fetus, then it is more likely that severe complications may occur. These manifest as severe signs and symptoms in the baby, just after birth. In many instances, such an early infection may result in stillbirth or a spontaneous termination of pregnancy
  • Infected pregnant women may suffer a miscarriage, or the child may be stillborn or die just after birth (almost 30-50% of the times); if the condition is left untreated, or remains undetected
  • The outcomes are poorer in individuals diagnosed with AIDS/HIV infection, or other opportunistic infections

Additional and Relevant Useful Information for Congenital Syphilis:

There are two routes for Treponema pallidum bacterium to infect and cause syphilis in a child:

  • One is via the fetal placenta route in a pregnant woman; causing Congenital Syphilis
  • The other is almost only, through sexual transmission; and this form is called Acquired Syphilis
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Maulik P. Purohit MD MPH

Assistant Medical Director, Medical Editorial Board, DoveMed Team


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