Syphilis is caused by the spirochete bacterium Treponema pallidum. The disease is transmitted sexually, but can also pass from an infected mother to her unborn child through the placenta, or when the child comes into direct contact with genital syphilitic lesions during birth. The infection of the child results in congenital syphilis. The World Health Organisation estimated that in 2008, 1.4 million pregnant women had an active syphilis infection, showing that syphilis continues to affect a large percentage of women worldwide, with the potential for lasting adverse effects on women and children’s health.
The likelihood of transmission from mother to child is dependent on the stage of infection in the mother. Sexually transmitted syphilis (also called acquired syphilis) develops in several stages: primary, secondary, latent, and tertiary. When left untreated, primary or secondary syphilis in the mother carries more than 30% risk of a stillbirth (a baby born dead) or early infant death. Even if the child survives to term, there is a more than 40% risk that the child will be infected with syphilis. In the latent and tertiary stages, the risk of stillbirth and transmission is lower, but transmission still occurs in one-fifth of cases. This is also mirrored in the level of syphilis infectivity during sexual transmission: primary and secondary syphilis are highly infectious, while late latent and tertiary stages of syphilis are non-infectious.
How does congenital syphilis affect children?
Infected children may show no symptoms of syphilis at the time of birth, but symptoms may develop over a period of time. Congenital syphilis is divided into stages: early and late. These classifications are based on the stage at which symptoms of syphilis become apparent. Early congenital syphilis occurs in children aged between 0 to 2 years old, while late congenital syphilis occurs in children aged 2 years and above. As in acquired syphilis, congenital syphilis produces a wide range of symptoms. Early congenital syphilis can manifest in several ways, such as premature birth, low birth weight, jaundice, an enlarged spleen and liver (known as hepatosplenomegaly), and even death shortly after birth. Rhinitis is also often present, which involves a heavy – occasionally bloody – discharge from the nose (“snuffles”), sometimes accompanied by laryngitis. The nasal discharge is full of T. pallidum, and is highly infectious; as such, any person handling the child must take appropriate precautions during direct contact to avoid infection.
Late congenital syphilis manifests in a series of developmental abnormalities, such as the commonly found Hutchinson’s teeth, saddle nose (where the bridge of the nose is absent), swollen knees, deafness, and interstitial keratitis (an inflammation of the cornea). A certain percentage of children may also develop neurosyphilis, which is detected through serological testing of cerebrospinal fluid. This may be asymptomatic, but can cause damage to the central nervous system, leading to mental retardation.
How can congenital syphilis be prevented?
Because of the serious and potentially fatal consequences of congenital syphilis, routine testing for syphilis in pregnant women is recommended. Penicillin is the gold standard for syphilis treatment. Pregnant mothers who are found to be infected with syphilis can be treated with penicillin intravenously. This has a high success rate (more than 90%) in preventing transmission to her unborn child. However, late penicillin treatment (taking place less than 4 weeks before birth) is less likely to eradicate infection in the unborn child, one more reason to be tested early.
If an infant is found to be infected with syphilis, early detection and penicillin treatment are essential for preventing developmental abnormalities that arise from congenital syphilis. This is particularly important as the damage already caused by syphilis cannot be reversed, and will have serious lasting consequences on the life of the child. Testing for syphilis infection in newborns is performed using the same method as in adults, specifically through the detection of T. pallidum antibodies that indicate an immune response against the infection.
While syphilis can be cured, it is possible for a person to be re-infected if they are again exposed to syphilitic lesions. This means that pregnant women who have been successfully treated for syphilis must still maintain constant vigilance to protect themselves and their child from re-infection, and to seek immediate treatment if re-infection occurs. Pregnant women should also ensure that their sex partners are also tested and treated for syphilis to reduce their likelihood of re-infection.
Early detection and diagnosis is essential to protect yourself and your unborn child from the severe consequences of syphilis infection. Detecting syphilis infection is quick and easy using our Syphilis Home Test Kit, which uses the same method of detection as that of hospital laboratories worldwide. The kit requires only 1 – 2 drops of blood from a finger prick and gives you with a reliable and accurate result in 15 minutes. It is safe and easy to use.