Syphilis During Pregnancy

What is syphilis?

Syphilis is a serious infection caused by the bacteria Treponema pallidum. It is usually passed from one person to another by sexual contact. If it is not treated, syphilis can lead to brain, nerve, and tissue damage that cannot be repaired. If you are pregnant and have syphilis, you can pass the infection to your baby before or during birth. The infection can seriously harm the baby.

How does it occur?

The bacteria that cause syphilis enter the body through an opening such as the vagina, mouth, or rectum. They can also enter through a cut or break in the skin or through blood transfusions.

If syphilis occurs during pregnancy and is not treated, the baby will probably get the disease. The mother's infected blood reaches the baby through the placenta.

What are the symptoms?

Symptoms may begin 10 to 90 days after getting the disease. Possible symptoms include:

• smooth, red, painless sores (called chancres), usually in or near the vagina or vulva
• a pink or red, bumpy, scaling skin rash that does not itch and may come and go (you can easily infect other people with this rash, which may include spots on the palms of the hands and soles of the feet)
• brown sores about the size of a penny
• swollen lymph glands
• flu symptoms such as fever, body aches, sore throat, headaches, tiredness, and loss of appetite
• hair loss in clumps
• gray or pink patches of fatty tissue in damp areas of the body (also highly infectious)
• wartlike growths in the anal area

In advanced stages, the disease can cause tumors on the skin and bones. It can affect the brain, the aorta (the blood vessel that leads from the heart), and the heart. This can lead to heart problems and brain damage. There is also a stage called the "Latent Phase" where there are no symptoms.

Some babies infected with syphilis are born prematurely. Many infected babies have no symptoms at birth, but symptoms develop weeks or months later. Problems in newborns with syphilis may include:

• premature birth
• swollen lymph nodes
• swelling of the whole body (edema)
• enlarged liver and spleen
• growth retardation
• birth defects (for example, problems with the eyes or central nervous system)
• hearing problems
• bone problems with pain
• blisterlike rash
• yellowish skin (jaundice)
• anemia
• dental problems
• flattened nose (called Saddle nose)

Some pregnancies infected with syphilis can result in a stillbirth.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and examine you. Your provider will look for chancres on your skin and in your vagina, cervix, and rectum. If you have sores, scrapings from the sores will be examined under a microscope to look for bacteria.

You will have a screening blood test. (All women have a blood test for syphilis at their first prenatal visit.) If the screening test suggests the possibility of a syphilis infection, you will have a more specific blood test to confirm the diagnosis.

Diagnosis of a newborn with syphilis is based on a history of the mother having syphilis, an exam of the baby, blood tests, and possibly X-rays.

People who get syphilis also have a higher risk of getting HIV. If you get syphilis, your healthcare provider may recommend testing for HIV or other sexually transmitted diseases.

How is it treated?

Syphilis is usually treated with shots or oral doses of penicillin. If you are allergic to penicillin, your healthcare provider may ask you to undergo a special procedure that will allow you to take penicillin since it is the best treatment for syphilis in pregnancy. Treatment for syphilis before the 16th to 18th week of pregnancy usually prevents babies from getting syphilis. Later treatment may lessen your baby's infection, but your baby may be born with some problems caused by syphilis.

A baby born with syphilis will be treated with penicillin given as a shot or intravenously (IV).

Cases of syphilis are required by law to be reported to the local health department. You must tell the proper authorities about all the people with whom you have had sexual contact.

Even if you have been treated for syphilis, you can get syphilis again if you are exposed again.

How long will the effects last?

If you are treated soon after you become infected with syphilis, the baby may have no problems at all and you will probably be cured. However, if you do not get early treatment or you are infected during the second half of your pregnancy, the baby may have severe problems. Some babies infected during pregnancy may not survive.

You will have monthly blood tests after your treatment to be sure the treatment is effective.

How can I take care of myself?

Follow your healthcare provider's instructions and take all of your medicine as prescribed. Be sure to tell your provider if you are allergic to penicillin or other medicines.

You should tell your sexual partner you have syphilis. If he has the disease and is not treated, he can reinfect you or infect someone else.

What can I do to help prevent syphilis?

If you have syphilis, you can help prevent spread of the infection if you:

• Get treatment right away to stop spread of the disease to your baby.
• Do not expose others to your body fluids and open sores. Do not have sexual intercourse or other intimate physical contact with anyone until you have been treated.
• Tell anyone with whom you have had sexual contact about your infection. Urge them to see a healthcare provider so they can be tested for syphilis.
• Wash your hands after you use the toilet and before you touch food, dishes, or utensils.

You can reduce your risk of getting syphilis from someone else if you:

• Use latex or polyurethane condoms every time you have sex.
• Have just 1 sexual partner who is not sexually active with anyone else. Make sure your partner has been tested for syphilis.