Congenital Syphilis

What is Congenital Syphilis?

Congenital syphilis is a serious infection that happens when a pregnant mother with syphilis passes the bacteria to her baby during pregnancy. The bacteria crosses the placenta, which is the organ that connects mother and baby in the womb. This infection can happen at any stage of pregnancy.

Syphilis is caused by a bacteria called Treponema pallidum. When left untreated in pregnant mothers, this bacteria can cause severe health problems for the baby. Some infants show signs of infection at birth. Others may not develop symptoms until weeks or months later.

Congenital syphilis is preventable with early testing and treatment during pregnancy. When mothers get tested and treated before or during pregnancy, the risk of transmission drops significantly. This is why screening for syphilis has become a standard part of prenatal care in the United States.

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Symptoms

Some babies with congenital syphilis show no symptoms at birth. When symptoms do appear, they can range from mild to severe.

Low birth weight or failure to thrive after birth
Skin rash or sores, especially around the mouth, genitals, and anus
Fever and irritability
Swollen liver and spleen
Anemia, which means low red blood cell count
Jaundice, which is yellowing of the skin and eyes
Thick or bloody nasal discharge
Bone pain or abnormal bone development
Swollen lymph nodes
Brain and nervous system problems

Without treatment, late symptoms can develop during childhood. These include bone deformities, tooth problems, hearing loss, vision problems, and developmental delays. Early treatment prevents these serious complications.

Causes and risk factors

Congenital syphilis happens when a mother with untreated syphilis passes the Treponema pallidum bacteria to her baby during pregnancy. The bacteria crosses through the placenta and infects the developing fetus. A mother can transmit syphilis at any stage of pregnancy, but the risk is highest when the mother has an active, untreated infection.

Risk factors include lack of prenatal care, having multiple sexual partners during pregnancy, substance use, and living in areas with high rates of sexually transmitted infections. Mothers who have syphilis but do not know their status pose the greatest risk. Inadequate treatment during pregnancy also increases the risk of transmission. Even mothers who were treated for syphilis in the past can get reinfected if exposed again during pregnancy. This is why testing during pregnancy is critical for prevention.

How it's diagnosed

Congenital syphilis is diagnosed through blood tests performed on pregnant mothers and newborn infants. During pregnancy, healthcare providers screen mothers using tests that detect antibodies to the Treponema pallidum bacteria. These include the RPR test, T. Pallidum antibody test, and Treponema pallidum particle agglutination test. A positive test means the mother has been exposed to syphilis and may need treatment to protect her baby.

Rite Aid offers syphilis testing as an add-on to our preventive health panel. Testing during pregnancy helps identify mothers who need treatment before the bacteria can harm their baby. After birth, doctors may test the baby's blood, examine the placenta, and perform physical exams to check for signs of infection. Early detection allows for immediate treatment and better outcomes for the infant.

Treatment options

Antibiotic treatment with penicillin is the primary treatment for both mother and baby
Pregnant mothers receive penicillin injections to treat their infection and prevent transmission
Infants born with congenital syphilis receive intravenous penicillin for 10 to 14 days
Follow-up blood tests monitor treatment success and check for decreasing antibody levels
Regular pediatric care tracks growth, development, hearing, and vision
Early intervention services help address any developmental delays
Mothers should avoid sexual contact until treatment is complete and tests show the infection is gone
Partners of infected mothers also need testing and treatment to prevent reinfection

Treatment is most effective when started early. Infants treated within the first few months of life have the best chance of avoiding long-term complications. Parents should work closely with their pediatrician and follow all recommended treatments and follow-up appointments.

Frequently asked questions

Yes, congenital syphilis is highly preventable with early testing and treatment during pregnancy. When pregnant mothers are tested and treated with penicillin before or during pregnancy, the risk of transmission to the baby drops dramatically. This is why syphilis screening is a standard part of prenatal care in the first trimester and again in the third trimester for women at higher risk.

Untreated congenital syphilis can cause severe and permanent complications including bone deformities, developmental delays, seizures, hearing loss, and vision problems. In the most serious cases, it can lead to stillbirth or infant death. Long-term effects may not appear until childhood, but they are often irreversible by that point. Early treatment prevents most of these complications.

Many people with syphilis have no symptoms, especially in the early stages. The only way to know for sure is through blood testing. Your healthcare provider should test you for syphilis at your first prenatal visit. If you are at higher risk, you may be tested again in the third trimester and at delivery.

Breastfeeding is generally safe if you have been treated for syphilis and have no sores on your breasts. The bacteria does not pass through breast milk. However, if you have syphilis sores on your breast or nipple, you should not breastfeed until those sores heal completely. Talk to your doctor about the safest feeding options for your situation.

Syphilis blood tests are highly accurate when used together. Screening tests like the RPR test detect antibodies your body makes in response to infection. Confirmatory tests like the T. Pallidum antibody test verify the diagnosis. Using both types of tests minimizes false positives and false negatives, giving you reliable results.

It depends on when you were treated and how your body responded to treatment. If you were treated early in pregnancy and follow-up tests show your infection cleared, your baby may not need treatment. However, if you were treated late in pregnancy or did not respond well to treatment, your baby will likely need antibiotic treatment after birth. Your doctor will make this decision based on test results and timing.

Syphilis does not come back after successful treatment, but you can get reinfected if you are exposed to the bacteria again. This is why partners also need testing and treatment. After treatment, you should have follow-up blood tests to confirm the infection is gone. If you are pregnant, getting reinfected can still put your baby at risk.

Long-term effects depend on how early the infection is treated. Babies treated within the first few months usually develop normally. Without early treatment, children may develop bone and teeth abnormalities, hearing loss, vision problems, scarring of the cornea, and intellectual disabilities. Some effects appear years after birth, which is why ongoing monitoring is important even after treatment.

Yes, your partner absolutely needs testing and treatment if you have syphilis. Syphilis spreads through sexual contact, so your partner likely has the infection too. Treating only one partner can lead to reinfection. Both partners should avoid sexual contact until treatment is complete and follow-up tests show the infection is gone.

Most pregnant women should be tested for syphilis at their first prenatal visit. Women at higher risk, including those with multiple partners, a history of sexually transmitted infections, or substance use, should be tested again in the third trimester and at delivery. Your healthcare provider will recommend a testing schedule based on your individual risk factors.