Fetuses infected with syphilis often die in the womb, says Damian P. Alagia III, MD, a senior medical director of women’s health for Quest Diagnostics who is based in the Washington, DC, area. “About 40 percent to 50 percent of babies infected with syphilis will be stillborn,” Dr. Alagia says. Infected newborns are also at high risk for death. A baby with syphilis that survives but goes untreated or is inadequately treated can wind up with huge problems that last for life. “Syphilis is an equal opportunity destroyer,” Alagia says. “It doesn’t miss much.” The disease can aggressively attack almost every part of the body in fetuses and infants just as it does in adults, he explains.
A Completely Preventable Illness
“It’s gut-wrenching to talk about [congenital syphilis] because it’s preventable,” Alagia says. Very few babies would ever contract this potentially deadly disease if all pregnant women received proper prenatal care, he adds. The key is for every expectant woman to be tested for syphilis and other STDs and receive treatment if needed. If you test negative early in your pregnancy for syphilis or other STDs and then start to engage in high-risk behaviors or have a new partner, you should be retested in the third trimester to protect yourself and the baby, says Alagia. Testing for syphilis is critical, because you can have it without knowing. The initial sores are painless. They can be hard to see or completely hidden inside your body. They are also easy to mistake for something else, such as an ingrown hair, pimple, or harmless bump. (1)
Syphilis Treatment Is Highly Effective
Syphilis only strikes babies of pregnant women who do not get diagnosed and treated correctly with antibiotics. Penicillin is highly effective at protecting both mother and child, according to the Centers for Disease Control and Prevention (CDC) — but not getting a diagnosis or not taking penicillin significantly increases the health risks for both. (2)
A Trend of Increased STDs
Public health experts know how to effectively prevent and treat STDs, including syphilis and congenital syphilis. Local health departments play a vital role in this regard, but they may lack the funding they need. As a result, syphilis rates have reached a 20-year high, and congenital syphilis increased 87 percent between 2012 and 2016, with the CDC continuing to monitor what it calls a “sharp increase in the number of babies born with syphilis in the United States.” (3) Disparities exist in the impact that syphilis has on women and children of different population groups in the United States, as outlined in the CDC’s 2020 data: (4)
Among infants born to white women, there were about 27.5 babies with congenital syphilis for every 100,000 live births.The rate was about 5 times higher for infants born to Black mothers, with 134.9 infected babies per 100,000 live births.And among infants born to Hispanic mothers, the rate was about 2.6 times higher, with 71.9 infected babies per 100,000 live births.
Uneven access to prenatal care among women of different races and ethnicities largely explains these disparities. But as the CDC notes, the rates for all groups have been rising precipitously, year by year, for the past decade.
Transmission Risk Varies
If an infected woman is diagnosed and treated correctly before the fourth month of her pregnancy, the fetus will not contract the infection. Treatment after the fourth month will usually cure both mother and fetus. (2) The likelihood that your fetus will contract the infection also depends upon the stage of your syphilis. The more recently you contracted syphilis, the higher the risk that you will pass that infection on to the fetus. If you have early, untreated syphilis, the infection is almost always transmitted to the fetus. Mother-to-child transmission is much less common if you are in the latent or late (tertiary) stage of the illness.
Severity in Newborns Varies Widely
Some newborns infected with syphilis have no symptoms at all, or the symptoms may be so extreme that they cause brain damage and death. At birth, a child who has the infection may not have a positive blood test, because the disease can take weeks to show up on those tests. For this reason, if you are considered high-risk for having syphilis, your baby needs to have blood tests done every few weeks after birth.
Syphilis Symptoms in Infants
Early in the course of the illness, infants will have skin eruptions with fluid-filled blisters on the palms of their hands and soles of their feet. Dry sores that cluster to form rashes will also break out on or around the baby’s mouth, nose, and diaper area. Their noses may produce a puslike or bloody discharge. The infant’s lymph nodes will swell. Infected infants often fail to thrive. The child’s brain, spinal cord, and structures in the eyes, including the retina, may all become inflamed. Great harm can result, including blindness, deafness, severe intellectual deficits, and death. Congenital syphilis can cause major structural damage to the child’s body, including misshapen bones in the legs called “saber shins.” The jawbone and teeth may not develop correctly. Infected babies may grow teeth that are smaller and more widely spaced than normal. Their front teeth, or incisors, may have deep notches rather than having normal flat bottom edges for biting. (5) No baby should ever face such hardship when prevention is possible. If you are pregnant, it is vital for you to get prenatal care. If you can’t afford health insurance or don’t have your own doctor, turn to one of these trusted sources for women’s reproductive health care:
Planned Parenthood Community Health Centers
“If you’re pregnant, get a test, not just for syphilis also for the other STIs [sexually transmitted infections]. That is just routine,” says Alagia. “Identify it early, have it treated early, and you and your baby are fine.”
