Syphilis is a bacterial infection that can cause serious potentially life-threatening problems if not treated. It is caused by the bacterium Treponema pallidum, and usually spreads through sexual contact. However, syphilis can also be transmitted via blood transfusion or congenitally from a pregnant woman to her developing fetus. Untreated maternal syphilis or late or ineffective treatment can cause adverse birth outcomes (ABOs), including stillbirth (most common), miscarriage, neonatal death, prematurity, low birth weight, congenital syphilis (which is often fatal) and other congenital deformities.
According to the World Health Organization (WHO), syphilis is a common sexually transmitted infection, with about 6 million new cases reported each year worldwide. Congenital syphilis (when the disease is transmitted from the infected mother to her unborn infant) is identified as the second leading cause of preventable stillbirth globally, after malaria.
In 2016, the WHO recorded around 661,000 cases of congenital syphilis globally, resulting in over 200,000 stillbirths and neonatal deaths.
Take note! Syphilis is curable but prevention is the best.
Syphilis during pregnancy
Mother-to-child transmission of syphilis can lead to devastating consequences. According to the US CDC, stillborn or neonatal death occurs in about 40 per cent of untreated maternal syphilis cases. Infants with congenital syphilis are susceptible to bone damage, severe anemia, enlarged liver and spleen, jaundice, nerve problems (which can lead to blindness or deafness), meningitis, or skin rashes.
The bacteria that cause syphilis can remain inactive in the body for years without showing any symptoms. This means you may be infected with syphilis for years without noticing any symptoms. The disease develops in stages, and symptoms may differ with each stage. It may start as a painless sore (known as chancre), typically on the genitals, rectum or mouth. Because chancre is usually painless, it often goes unnoticed. The sore typically heals on its own within three to six weeks.
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Symptoms of secondary syphilis include rash on the entire body, wartlike sores in your mouth or genital area, hair loss, muscle aches, fever, sore throat, and swollen lymph nodes.
Without treatment, the disease may progress to the third stage, known as tertiary syphilis, where it can damage the brain, nerves, eyes, heart, blood vessels, liver, bones and joints.
Usually congenital syphilis presents no symptoms, but some newborns with the infection may experience a rash on the palms and the soles.
Blood tests can confirm syphilis. There are rapid tests that can provide results in less than 20 minutes. Early identification of the infection and treatment can prevent further transmission and adverse outcomes.
Treatment of syphilis
If left untreated, the infection lasts for many years and develops through different stages. Syphilis is treated with injectable penicillin benzathine. 1 to 3 doses of penicillin may be required depending on the stage of the disease. Congenital syphilis can only be prevented with penicillin. Syphilis during pregnancy should be treated immediately after diagnosis. The penicillin regimen should be initiated 30 days or more before delivery, as per the CDC.
Partner(s) of the infected woman is also recommended to receive penicillin treatment to prevent the mother from becoming re-infected.
Babies born to mothers with syphilis need to be screened for congenital syphilis at birth, and provided treatment if found positive. They should also be closely followed post-delivery, as congenital syphilis may not present any initial symptoms at birth and may appear later, if not treated appropriately.
Infants with congenital syphilis should be treated appropriately within the first 3 months of life to reduce the risk of developing lifelong complications related to the disease such as deafness, blindness, and intellectual disability.
How to prevent Congenital syphilis
Practicing safe sexual intercourse is the best way to prevent syphilis. Congenital syphilis can be prevented if pregnant women infected with syphilis is provided proper treatment with benzathine penicillin early during antenatal care, ideally before the second trimester.