Congenital Syphilis

Overview

Congenital syphilis (say: kon-JEN-ih-tul SIFF-uh-liss) is an infection a baby gets from its mother during pregnancy or at birth. It happens when the mother has syphilis — a common infection caused by bacteria (tiny germs) that is usually passed on through sex — and it is not treated before or during pregnancy. The bacteria can travel from the mother's body across the placenta (the organ that feeds the baby in the womb) and into the baby. Congenital syphilis can be serious, but it is also one of the most preventable conditions in pregnancy. If syphilis is found and treated early, the baby is usually protected.

Congenital syphilis is uncommon in the UK, but the number of cases has been rising in recent years, in line with rising syphilis rates among adults. Worldwide it is a significant problem, and health organisations consider it a condition that should be eliminated through pregnancy screening and treatment.

Symptoms

Common symptoms

• No visible signs at all — this is very common, and many babies seem perfectly well at birth
• A rash, often on the palms of the hands, soles of the feet, or around the nappy area
• A runny nose, sometimes with a sticky or bloody discharge (doctors call this 'snuffles')
• Yellowing of the skin and eyes (jaundice)
• Poor feeding, slow weight gain, or being unusually sleepy or unsettled
• A swollen liver or spleen, which a doctor may feel when examining the baby's tummy
• Swelling or pain in the arms and legs, or holding a limb still because it hurts
• Anaemia (a low level of red blood cells), which can cause pale skin and tiredness

Symptoms in children

• Some children who were not treated develop problems months or years later — this is called 'late congenital syphilis'
• Problems with the shape or strength of adult teeth that form in childhood
• Bone changes, especially in the shins and around the nose and forehead
• Hearing loss, which may come on gradually
• Eye problems, including blurred vision or inflammation inside the eye
• Joint problems, particularly swollen knees
• Learning, behaviour, or development difficulties in some children

Symptoms in older adults

• Congenital syphilis is an infection present from birth, so it is not something that first appears in older adults
• Adults who had untreated congenital syphilis as children may live with long-term effects such as hearing loss, vision problems, or bone changes, and need ongoing specialist care

Causes

Main causes

• A mother with syphilis passes the bacteria to her baby across the placenta during pregnancy, or through contact with a sore during birth
• The risk is highest when the mother's infection is recent or in its early stages, but it can happen at any stage of syphilis if it is not treated
• A mother can become infected during pregnancy after her routine blood test was done, so repeat testing may be needed if there is any new risk

Risk factors

• No antenatal (pregnancy) care, or care that started late in pregnancy
• Not being offered or not receiving a syphilis blood test in pregnancy
• A partner with syphilis, or more than one sexual partner during pregnancy
• A new sexual partner during pregnancy
• Living with HIV (the virus that causes AIDS), which can raise the chance of passing syphilis on
• Use of drugs or alcohol, or unstable housing, which can make it harder to access regular care
• Being diagnosed with another sexually transmitted infection during pregnancy

When to see a doctor

See a doctor urgently if:

• You are pregnant and have been told your partner has syphilis, or you have a painless sore, rash, or unusual discharge
• You are pregnant and have not had any antenatal blood tests
• Your baby has a rash, yellow skin, a constant runny nose, or is feeding poorly
• Your baby seems to be in pain when their arms or legs are touched

Book a routine appointment if:

• You are planning a pregnancy — a sexual health check before conceiving is a good idea
• You are pregnant and want to check that your syphilis test was done and what the result was
• You have questions about a result on your baby's blood test
• You or your partner would like testing for sexually transmitted infections for any reason

Diagnosis

Doctors diagnose congenital syphilis by looking at the mother's and baby's blood test results together, plus a full physical examination of the baby. Because many babies have no signs at all, blood tests are the key. Your doctor may also check the placenta (afterbirth) after delivery, and sometimes arrange other tests if the baby has symptoms. A specialist team — usually involving paediatricians (children's doctors) and sexual health or infection specialists — will guide the process.

Tests that may be done

• A blood test for the mother, usually done as part of routine pregnancy screening
• A blood test for the baby, comparing the results with the mother's
• A full physical examination of the baby, including the skin, tummy, eyes, and limbs
• X-rays of the baby's long bones, which can show typical changes
• Sometimes a lumbar puncture (a small sample of fluid from around the spine) if the doctor needs to check whether the infection has reached the nervous system
• Checking the placenta after birth, and sometimes other samples such as fluid from a rash or the nose
• Follow-up blood tests over several months to make sure treatment has worked

What to expect at your appointment

Some results come back within a few days, but others — especially the more detailed tests — can take a week or two. If your doctor thinks your baby needs treatment, they will usually start it straight away rather than wait for every result, because early treatment is safer. You will be given clear explanations at each step, and you can ask for an interpreter, written information, or extra time with the team if that helps.

Treatment

Congenital syphilis is treatable, and treatment works best when it starts as early as possible. Babies who need treatment usually receive antibiotics in hospital, where staff can watch them closely. The mother also needs treatment for her own infection, and her sexual partner(s) should be tested and treated too so that reinfection does not happen.

Self-care at home

• Keep every follow-up appointment, even if your baby seems completely well — the check-ups are how the team confirms the infection has gone
• Attend your own treatment and follow-up appointments as well as your baby's
• Ask your partner or partners to be tested and treated — this protects you, your baby, and future pregnancies
• Continue breastfeeding if you wish; syphilis is not passed through breast milk, though any sores on the breast should be checked by a doctor first
• Write down questions as they come to you, and take someone with you to appointments if that helps
• Ask your health visitor, midwife, or GP for extra support if feeding, sleeping, or worry is becoming hard to manage

Medical treatments

The main treatment is a course of antibiotics given by injection, usually in hospital for babies. How long the course lasts depends on the baby's test results, symptoms, and whether the infection is thought to have reached the nervous system. Some babies only need monitoring rather than treatment, if their tests show they are not infected. Mothers are treated with antibiotics too, and partners are offered testing and treatment. Babies are then checked with repeat blood tests for several months to confirm the infection has cleared. Your medical team will explain the exact plan for your child.

When is surgery considered?

Surgery is not usually part of treating the infection itself. In rare cases, older children with late effects — such as significant eye or ear problems — may be referred to specialist surgical or medical teams for help with those specific issues.

Living with this condition

For most families, life after treatment settles into a normal routine of feeds, cuddles, and check-ups. The main practical difference is a schedule of follow-up blood tests and developmental reviews over the first year or so. Keep a simple file or phone note of appointment dates and results, and don't be afraid to ask what each result means. If your child needs hearing or eye checks later, these are quick and gentle and help catch any problems early.

Lifestyle tips

• Use condoms with new or untested partners, and encourage regular sexual health checks for you and your partner
• Tell any future pregnancy care team about this history early, so screening and treatment can be arranged quickly
• Avoid sharing information about your child's diagnosis more widely than you need to — you decide who knows
• Keep up routine childhood health checks, vaccinations, and developmental reviews
• Look after your own health too — sleep, food, and support matter while you are caring for a baby

Diet and exercise

Babies with congenital syphilis should be fed as normal — breast milk or formula — and helped to feed well, with extra support if feeding is difficult. Older children should be encouraged to eat a varied diet and to play and move about as they normally would. If your child has bone or joint problems, ask your doctor or physiotherapist what activity is safe; gentle movement is usually encouraged.

Mental health and emotional wellbeing

Being told your baby has an infection can bring up a lot of feelings — shock, guilt, anger, fear, or all of these at once. These feelings are normal and understandable, and you deserve support with them. Some parents also face stigma around sexually transmitted infections, which can make it harder to talk. You do not have to cope alone: talking to a midwife, health visitor, GP, or a counsellor can help a great deal. If at any point you feel you cannot cope, or you have thoughts of harming yourself, please contact a crisis support service in your country straight away, or go to your nearest emergency department.

Prevention

Yes — congenital syphilis is largely preventable. The single most effective step is testing every pregnant woman for syphilis early in pregnancy, and treating any infection straight away. Treating the mother also protects the baby in most cases. Using condoms and having regular sexual health checks reduces the chance of getting syphilis in the first place, and treating partners helps prevent reinfection.

Vaccines

There is currently no vaccine to prevent syphilis. Prevention relies on screening, prompt antibiotic treatment, and safer sex practices.

Screening programmes

In the UK and many other countries, all pregnant women are offered a syphilis blood test as part of routine antenatal screening, usually in early pregnancy. If you are at higher risk — for example, a new partner during pregnancy — your team may offer a repeat test later in pregnancy. You can ask for a test at any time at a sexual health clinic, and it is usually free and confidential.

Complications

If left untreated

• Stillbirth (the baby dying before birth) or death in the first weeks of life
• Being born early (premature birth) or with a low birth weight
• Serious infection in the baby's organs, including the liver, brain, and lungs
• Bone and joint changes that can affect movement
• Hearing loss that may be permanent
• Eye problems, including inflammation that can affect vision
• Anaemia and other blood problems
• Developmental or learning difficulties in some children

Long-term outlook

The outlook is good for most babies who are treated promptly, and many go on to lead completely healthy lives. Once treatment is finished and follow-up tests confirm the infection has cleared, your child can be discharged from specialist care. Some children need longer monitoring of hearing, vision, or development, and a small number will need ongoing support for long-term effects. Your medical team will tell you honestly what to expect for your child and will plan care around your family's needs.

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