Congenital Syphilis

In recent years, public concern about sexually transmitted diseases has focused mainly on AIDS. Older sexually transmitted diseases, however, have not gone away. In fact, reported cases of syphilis—a bacterial infection that was one of the first sexually transmitted diseases ever recognized—have steadily increased since the mid-1980s.

Because syphilis is on the rise among adults, an increasing number of infants are being born with congenital syphilis contracted from their mothers during gestation. In the early 80s, fewer than 60 cases of congenital syphilis were reported in New York City each year. Since 1990, the yearly case count has exceeded several thousand.

HOW DOES CONGENITAL SYPHILIS DEVELOP?
The organism that causes syphilis, a spiral-shaped bacterium called Treponema pallidum, passes from an infected mother to the fetus through the placenta. Although maternal-fetal transmission can occur thoughout pregnancy, it is most likely if the mother has untreated, active syphilis beyond the sixteenth week. As many as 80 to 95 percent of unborn infants exposed to syphilis are born with the congenital form of the disease. In about 40 percent of cases, fetal infection with syphilis results in stillbirth or death within a few weeks after birth. The disease also can be transmitted at the time of delivery if the mother has an active lesion on the genitalia.

HOW CAN THE PEDIATRICIAN TELL IF AN INFANT HAS CONGENITAL SYPHILIS?
If the mother had syphilis during pregnancy, the pediatrician will be alert to the possiblity of infection in the newborn. Many obstetricians perform blood tests for syphilis and other infections in all their expectant patients as soon as pregnancy is confirmed. Treating the mother greatly reduces the chance that the fetus will be infected.

All newborns exposed to syphilis prenatally—even those born without symptoms—should be tested for the disease immediately after birth and at regular intervals during the first few months of life. Other diagnostic tests that may be needed include a spinal tap and X rays of the long bones.

WHAT HAPPENS DURING SYPHILIS INFECTION?
A newborn with congenital syphilis may have symptoms immediately after birth or seem normal for the first two to three weeks of life. Symptoms include severe pneumonia, poor feeding, swelling of the liver and spleen, jaundice, fever and anemia.

After the first week, skin sores develop, and in the second week, some infected infants develop a nasal discharge ("snuffles") that contains syphilis bacteria. Wartlike lesions develop in the mucous membranes, and hair and nails may be lost. The disease also weakens the bones and leads to depression of the nasal bridge. Without treatment, all organ systems are eventually affected.

WHAT TREATMENTS ARE AVAILABLE?
Penicillin will be recommended for the newborn, the dose and duration of treatment depending upon what previous treatment the mother has received.

PREVENTING CONGENITAL SYPHILIS
To prevent congenital syphilis, pregnant women who are at risk of contracting sexually transmitted diseases should have blood tests for syphilis in the first and third trimesters. Penicillin treatment should begin immediately if the infection is present. Once treatment starts, monthly antibody tests should be done to make sure the infection is eradicated. If an infected woman is treated before the eighteenth week of pregnancy, chances are excellent that her child will escape the infection.

Excerpt from THE DISNEY ENCYCLOPEDIA OF BABY & CHILD CARE, © 1995 DSH Communications, Inc. This material is based on current medical research and, to the best of the editors' knowledge and understanding, is accurate and valid. However the reader should not use information contained in this material to alter a medically prescribed regimen or as a form of self-treatment, without seeking the advice of a licensed physician.