Congenital syphilis is a severe multisystem infectious disease that occurs in infants who are infected with Treponema pallidum, the bacterium that causes syphilis, while in utero. The transmission occurs from an infected mother to her fetus through the placenta, typically during the early stages of pregnancy. The condition manifests at birth or in early infancy and can result in a range of clinical symptoms.
Common manifestations of congenital syphilis include skeletal abnormalities (such as saber shins), hepatosplenomegaly, jaundice, anemia, thrombocytopenia, pneumonia alba (a form of interstitial pneumonitis), skin rashes, and neurological complications. Late-onset forms of the disease may present after the age of two years, with features such as interstitial keratitis, hearing loss, and dental abnormalities including Hutchinson's teeth and mulberry molars.
Diagnosis is typically based on a combination of clinical evaluation, maternal serological test results, and confirmatory testing in the infant. Laboratory tests may include non-treponemal assays (e.g., RPR or VDRL) and treponemal-specific tests. Direct detection of Treponema pallidum in bodily fluids or tissues via darkfield microscopy or PCR may also be performed.
Congenital syphilis is preventable through routine screening and treatment of syphilis in pregnant women. Early administration of penicillin to infected mothers significantly reduces the risk of transmission to the fetus. The World Health Organization (WHO) and other public health bodies emphasize the importance of antenatal screening programs to eliminate congenital syphilis.
Global health data indicate that congenital syphilis remains a cause of perinatal mortality and morbidity, particularly in low-resource settings where access to prenatal care is limited. Accurate surveillance and reporting vary by region, but efforts to improve maternal health and syphilis control are ongoing internationally.
Treatment of congenital syphilis in newborns involves administration of aqueous crystalline penicillin G, either intravenously or intramuscularly, depending on the clinical and laboratory findings. Follow-up evaluation is essential to ensure adequate response to therapy.
Prevention and control strategies focus on integrating syphilis screening into routine antenatal care, ensuring prompt treatment of infected women, and improving access to healthcare in underserved populations.