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Congenital syphilis

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.

Causes

Congenital syphilis is caused by the bacteria 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)
  • Rash of the mouth, genitals, and anus
  • Rash: starting as small blisters on the palms and soles, and later changing to copper-colored, flat or bumpy rash on the face, palms, and soles
  • Watery fluid 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, genitals, and anus

Exams 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
  • Dark-field examination to detect syphilis bacteria under a microscope
  • Eye examination
  • Lumbar puncture

Treatment

Penicillin is used to treat all forms of syphilis.

Outlook (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.

Possible Complications

Health problems that can result if the baby isn't treated include:

  • Blindness
  • Deafness
  • Deformity of the face
  • Nervous system problems

When to Contact a Medical Professional

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 plan to get pregnant), call your provider right away.

Prevention

Safer sexual practices help prevent the spread of syphilis. If you suspect you have a sexually transmitted disease such as syphilis, seek medical attention right away 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 so they can 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.

Alternative Names

Congenital lues; Fetal syphilis

References

Dobson SR, Sanchez PJ. Syphilis. In: Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ, eds. Feigin and Cherry's Textbook of Pediatric Infectious Diseases. 7th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 143.

Duff P. Maternal and fetal infections. In: Creasy RK, Resnik R, Iams JD, Lockwood CJ, Moore TR, Greene MF, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 7th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 51.

Update Date 11/19/2015

Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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