Congenital Syphilis

By Nina Dao

Syphilis has been plaguing Europeans since the sixteenth century. This sexually transmitted disease caused by Treponema pallidum, brought on a complex venereal disease that had varying stages from primary, secondary to tertiary.[1]Before the development of antibiotics the condition was not simple to treat. Symptoms range all throughout the body but most include commonly inflammation of the skin. It affects men, women, and even children. Today syphilis can be treated by antibiotics including penicillin. However, the antibiotics can only prevent future damage from syphilis, but cannot reverse damage already done. As a result of this, it is vital to get proper treatment as soon as possible when diagnosed. 

Syphilis is a chronic bacterial infection that is typically spread by sexual contact, but it can be spread through pregnancy or by birth from the mother to the child. The child has a higher risk of getting the same disease if the mother herself has it but leaves it untreated or is unaware she has the disease. Studies have shown that the first 4 years after contracting syphilis, a pregnant woman who has no treatment has a chance of 70 percent or higher of transmitting the bacterium Treponema pallidum to her baby, which can cause congenital syphilis.[2]Symptoms of congenital syphilis can appear any time from three to fourteen weeks old to as late as five years old. Some common symptoms include inflammation and hardening of the umbilical cord, rash, fever, low birth weight, anemia, aseptic meningitis, and more. If the patient is infected early, symptoms might not show immediately. Symptoms of the disease caught later in life may include bone pain, nerve deafness, retinitis pigmentosa and more. Symptoms for congenital syphilis appear unpredictably anywhere between the stated ages and can remain undiagnosed until adulthood. 

This image illustrates a baby affected with syphilis who is displaying physical symptoms.
Artist: E. Burgess
Medium: Watercolors
Year: 1878-1888
Link: https://wellcomecollection.org/works/z33nefwn

The rate of congenital syphilis has increased since 1985 according to the CDC.[3]This is related to the increase in cases of women having the disease. One of the possibilities as to why the cases are increasing is due to women experiencing the initial symptoms and not treating it. As stated before, syphilis is organized into three different stages such as primary, secondary, and tertiary. The primary stage typically consists painless genital sores. This symptom can often times be overlooked and therefore be untreated. As a result of this, it can pass the disease to the baby through fetal development in the womb or at birth.

In the United States, the rate of congenital syphilis did decrease from 1991 – 2005 but increased again from 2005 – 2008. The congenital rate among infants who are aged 1 year or older has increased 23%, from 8.2 cases per 100,000 live births in 2005 to 10.1 cases during 2008.[4]The rate then decreased to 8.4 cases per 100,000 live births from 2008 – 2012 and then increased to 11.6 cases per 100,000 live births in 2014.[5]This presents the highest rate reported in over 10 years.

Another factor as to why the cases of congenital syphilis is still increasing is location and social class. Areas where medical access is not attainable has a negative impact in terms of conditions and diseases not being treated properly, including prenatal care. With the lack of prenatal care, it leads to women not having suitable routine testing that could indicate a positive test for various conditions and diseases the baby might have including syphilis.

With the lack of knowledge and resources, these factors could indicate why the mortality rate for children suffering from congenital syphilis is relatively high. The infant mortality rate for babies with congenital syphilis has been high for over 100 years. In 1913 in Chelsea, it was recorded that a majority of the 112 infant deaths, most of the deaths that occurred in the first month of life and for children under 1 year old was a result of congenital syphilis.[6]In the City of Westminster, there were cases recorded of how many children had syphilis. The surveillance displayed a fluctuating number of cases from 7 cases in 1928, 20 in 1930, 27 in 1931, and 15 in 1937.[7]Another child died in 1937 in the City of Westminster.[8]The disease is still present and continues to take lives of children today due to the lack of knowledge and resources. 

An image emphasizing the affects of syphilis on infants.
Book: A treatise on syphilis in new-born children and infants at the breast
Author: Diday, P. 1812-1894.
Date: 1883
Link: https://wellcomecollection.org/works/vz5vvkt9

There are several ways to diagnose newborns if they are positive for congenital syphilis. The first method would be to conduct a dark-field microscopy or direct immunofluorescence on specimens from areas such as skin lesions, umbilicus or placenta.[9]The second method would be to test the mother to see if she has a reactive treponemal and nontreponemal exams and if the child exhibits classic signs of the disease.[10]The serological tests for syphilis, treponemal and nontreponemal, is extremely important to run on the mother because if she tests positive, the child has a 70 – 100% chance on contracting the same disease.[11]Another method is ultrasonography which provides a noninvasive examination for pregnant women for signs of fetal syphilis.[12]It is important to test the child again after the initial tests if it comes out negative yet the mother is positive for the disease.

After diagnosing the patient, it is vital that they are treated immediately. The best medication to treat and prevent congenital syphilis is penicillin. Penicillin G is the specific type that has shown promising treatment results.[13]Penicillin may not work for everyone due to certain allergies to it. Possible alternatives to penicillin for individuals allergic to it are azithromycin and ceftriaxone.[14]Penicillin is the top preferred antibiotic to use to treat syphilis among patients. The breakthrough of this antibiotic has allowed the numbers of syphilis cases to decrease or be treated appropriately. 

In order to have the rate of congenital syphilis to slow down or even decline, there needs to be changes within the system. Three primary goals to combat the issue are collaboration, resources, and education. Collaboration with health-care providers, health departments, health insurers, policymakers, and the public will allow the possibility to reduce syphilis among women, especially pregnant women.[15]This will then increase the opportunity for women to get the proper resources they need such as early prenatal care access and syphilis screening during pregnancy. These resources would need to be available for women of all types of background and social class. The syphilis screening exams need to be more readily available in areas with high syphilis rates. Lastly, education is key. By having more people aware of the disease, treatment, and resources available, it would decrease the rate and number of cases. Bringing education about the disease would enable individuals to know what proper steps they would need to take to treat or prevent congenital syphilis.

Overall, congenital syphilis is a disease that is still an issue in today’s world. It is preventable if men, women and children are given the proper resources to be screened and treated early. With women being more aware of the disease and its symptoms, the possibility of them being officially diagnosed and receiving treatment might alleviate the number of cases presented each year of infants having congenital syphilis. There are more resources present in modern medicine compared to 50 years ago that make the disease treatable and preventable.  


[1] Arrizabalaga, Jon. “Syphilis.” Chapter. In The Cambridge World History of Human Disease, edited by Kenneth F. Kiple, 1025–33. Cambridge: Cambridge University Press, 1993. doi:10.1017/CHOL9780521332866.196.

[2] Finelli, L, S M Berman, E H Koumans, and W C Levine. “Congenital Syphilis.” Bulletin of the World Health Organization76, no. 2 (1998): 126–28. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2305700/ .

[3] Zenker, Paul N., and Stuart M. Berman. “Congenital Syphilis: Trends and Recommendations for Evaluation and Management .” The Pediatric Infectious Disease Journal10, no. 7 (July 1991): 516–22. https://doi.org/10.1097/00006454-199107000-00008.

[4] “Congenital Syphilis—United States 2003-2008.” Annals of Emergency Medicine56, no. 3 (April 2010): 295–96. https://doi.org/10.1016/j.annemergmed.2010.06.002.

[5] Bowen, Virginia, John Su, Elizabeth Torrone, Sarah Kidd, and Hillard Weinstock. “Increase in Incidence of Congenital Syphilis — United States, 2012–2014.” MMWR. Morbidity and Mortality Weekly Report64, no. 44 (2015): 1241–45. https://doi.org/10.15585/mmwr.mm6444a3.

[6]https://wellcomelibrary.org/moh/report/b18110939/12#?m=0&cv=12&c=0&s=0&z=-2.022%2C-0.1052%2C5.008%2C1.955

[7]https://wellcomelibrary.org/moh/report/b18247994/79#?m=0&cv=79&c=0&s=0&z=0.437%2C0.5205%2C0.8541%2C0.3334

[8]https://wellcomelibrary.org/moh/report/b18247994/79#?m=0&cv=79&c=0&s=0&z=0.437%2C0.5205%2C0.854%2C0.3334

[9] Zenker, Paul N., and Stuart M. Berman, 516.

[10] Zenker, Paul N., and Stuart M. Berman, 516.

[11] Zenker, Paul N., and Stuart M. Berman, 517.

[12] Jr., George D. Wendel, Jeanne S. Sheffield, Lisa M. Hollier, James B. Hill, Patrick S. Ramsey, and Pablo J. Sánchez. “Treatment of Syphilis in Pregnancy and Prevention of Congenital Syphilis.” Clinical Infectious Diseases35, no. s2 (2002). https://doi.org/10.1086/342108.

[13] Jr., George D. Wendel, Jeanne S. Sheffield, Lisa M. Hollier, James B. Hill, Patrick S. Ramsey, and Pablo J. Sánchez, S200.

[14] Jr., George D. Wendel, Jeanne S. Sheffield, Lisa M. Hollier, James B. Hill, Patrick S. Ramsey, and Pablo J. Sánchez, S200.

[15] “Congenital Syphilis—United States 2003-2008”, 295.


Primary Sources:


Secondary Sources:

Arrizabalaga, Jon. “Syphilis.” Chapter. In The Cambridge World History of Human Disease, edited by Kenneth F. Kiple, 1025–33. Cambridge: Cambridge University Press, 1993. doi:10.1017/CHOL9780521332866.196.

Bowen, Virginia, John Su, Elizabeth Torrone, Sarah Kidd, and Hillard Weinstock. “Increase in Incidence of Congenital Syphilis — United States, 2012–2014.” MMWR. Morbidity and Mortality Weekly Report64, no. 44 (2015): 1241–45. https://doi.org/10.15585/mmwr.mm6444a3.

“Congenital Syphilis—United States 2003-2008.” Annals of Emergency Medicine56, no. 3 (April 2010): 295–96. https://doi.org/10.1016/j.annemergmed.2010.06.002.

Finelli, L, S M Berman, E H Koumans, and W C Levine. “Congenital Syphilis.” Bulletin of the World Health Organization76, no. 2 (1998): 126–28. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2305700/ .

Jr., George D. Wendel, Jeanne S. Sheffield, Lisa M. Hollier, James B. Hill, Patrick S. Ramsey, and Pablo J. Sánchez. “Treatment of Syphilis in Pregnancy and Prevention of Congenital Syphilis.” Clinical Infectious Diseases35, no. s2 (2002). https://doi.org/10.1086/342108.

Zenker, Paul N., and Stuart M. Berman. “Congenital Syphilis: Trends and Recommendations for Evaluation and Management .” The Pediatric Infectious Disease Journal10, no. 7 (July 1991): 516–22. https://doi.org/10.1097/00006454-199107000-00008.