Syphilis treatment journey in infants

Overview

Syphilis is a bacterial infection that can be passed from a pregnant woman to her baby during pregnancy or childbirth. When a baby gets syphilis this way, it is called congenital syphilis. With proper treatment, the infection can be cured, but without treatment it can cause serious health problems.

Congenital syphilis is rare in many high-income countries, but it is still a concern worldwide. Rates have increased in some regions in recent years, especially when pregnant women do not get tested and treated early.

Infants whose mothers have untreated or inadequately treated syphilis during pregnancy are at risk. The infection can affect babies of any race or ethnicity.

Symptoms

Common symptoms

• No symptoms at birth (most common)
• Rash on the palms of the hands and soles of the feet
• Fever
• Swollen lymph nodes (glands)
• Irritability or fussiness

Symptoms in children

• Same as above for infants. In older children, untreated congenital syphilis can cause bone pain, joint swelling, and vision or hearing problems.

Symptoms in older adults

• Generally not applicable, but adults who had untreated congenital syphilis as infants may develop late complications such as gummas (soft lumps) in skin or bones, neurological problems, or heart issues.

Causes

Main causes

• The bacteria Treponema pallidum causes syphilis.
• The infection is passed from a mother with syphilis to her baby during pregnancy (through the placenta) or during childbirth.

Risk factors

• Mother has untreated or late-treated syphilis during pregnancy
• Mother did not receive prenatal care
• Mother has a history of sexually transmitted infections
• Mother uses injection drugs

When to see a doctor

See a doctor urgently if:

• If your baby has a rash, fever, or seems very irritable
• If your baby is not feeding well or is losing weight
• If your baby shows any signs of infection (e.g., swollen glands, jaundice)

Book a routine appointment if:

• All babies born to mothers with syphilis should be tested and closely followed by a doctor
• Even if the baby looks healthy, follow-up appointments are essential to check for late signs

Diagnosis

Doctors diagnose congenital syphilis by taking a blood sample from the baby. They may also do a physical exam and sometimes test fluid from the spine (lumbar puncture) to check if the infection has spread to the brain.

Tests that may be done

• Blood test (serology) to look for antibodies against the syphilis bacteria
• Physical examination for signs of rash, bone problems, or enlarged organs
• Lumbar puncture (spinal tap) if the doctor suspects the infection has reached the nervous system
• X-rays or ultrasound to check for bone or organ damage

What to expect at your appointment

Testing is usually done in the hospital shortly after birth. The baby may need several blood draws and possibly a lumbar puncture. The procedures are done with care to minimize discomfort. Results often come back within a few days.

Treatment

Congenital syphilis is treated with antibiotics. The type and duration of treatment depend on how severe the infection is. Treatment is usually given through a vein (IV) or as an injection. The baby may need to stay in the hospital during treatment so doctors can monitor their response. Follow-up blood tests are needed to make sure the infection is gone.

Self-care at home

• Follow the treatment plan exactly as prescribed
• Keep all follow-up appointments for blood tests and check-ups
• Breastfeeding is generally safe while on treatment, but confirm with your doctor

Medical treatments

The main treatment is a course of antibiotics, usually given intravenously or by injection. Babies with more severe infection may need a longer course of treatment. The antibiotics kill the bacteria, but any organ damage that already occurred may need additional care from specialists.

When is surgery considered?

Surgery is not needed for the infection itself. However, if the infection caused bone or joint deformities, surgery might be considered later to correct those issues. This is rare.

Living with this condition

After treatment, most babies go on to live normal, healthy lives. They will need regular check-ups and blood tests for a year or two to confirm the infection is gone. During that time, watch for any new symptoms and keep all medical appointments.

Lifestyle tips

• Provide a healthy, nurturing home environment
• Keep up with the baby's regular vaccinations and wellness visits
• Practice good hygiene to prevent other infections

Diet and exercise

Breast milk or formula provides all the nutrition the baby needs. As the baby grows, introduce solid foods at the recommended age. No special diet is needed. Physical activity develops naturally as the baby reaches milestones.

Mental health and emotional wellbeing

Parents may feel worried or stressed about their baby's health. It is normal to have concerns. Talk with your healthcare team about any anxieties. They can connect you with counseling or support groups.

Prevention

Yes, congenital syphilis can be prevented by screening all pregnant women for syphilis early in pregnancy and treating any infections promptly. If a mother is treated before the 16th week of pregnancy, the baby is almost always protected.

Screening programmes

Pregnant women should have a blood test for syphilis at their first prenatal visit. Some women may need a repeat test later in pregnancy if they are at high risk.

Complications

If left untreated

• Bone deformities (such as a 'saddle nose' or bowed shins)
• Hearing loss or vision problems
• Neurological issues (developmental delays, seizures)
• Skin ulcers and gummas (soft tissue lumps)
• Dental abnormalities (notched front teeth)

Long-term outlook

With early and complete antibiotic treatment, the vast majority of babies recover fully without lasting problems. Even babies who already have some signs of infection do very well if treated promptly. The key is to diagnose and treat as early as possible.

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