Cases of congenital syphilis can be deadly. This chronic infectious disease is caused by contracting a treponema pallidum infection, resulting in an active syphilis condition being passed to a fetus in utero. “If a pregnant woman with active syphilis is not effectively treated, T. pallidum can cross the placenta and infect the fetus in utero. Mother-to-child transmission of syphilis imposes heavy economic and medical burdens worldwide,” according to Frontiers in Public Health. According to the World Health Organization, “Congenital syphilis is the second leading cause of preventable stillbirth globally.”
The statistics are downright frightening.
“Approximately 50% will be dead in utero, prematurely born, stillborn, or dead shortly after delivery,” according to the Journal of Clinical Infectious Diseases.
Data from The National Library of Medicine backed that up, reporting that “Up to half of all babies infected with syphilis in the womb die shortly before or after birth.”
But is syphilis common?
Syphilis, the sexually transmitted disease that leads to congenital syphilis, is extremely common. It is contracted by engaging in sexual acts without a condom and intimate skin-to-skin contact.
The U.S. Centers for Disease Control and Prevention (CDC) have reported a sharp spike in the number of syphilis cases in recent years. In 2022, the CDC released a report that stated an 80% rise in the number of cases in the United States from 2018 to 2022.
The New England Journal of Medicine considers the increase in congenital syphilis rates an “emerging public health concern.”
Syphilis is a highly treatable sexually transmitted disease, but it is pervasive around the world. Black women are diagnosed with syphilis at higher rates than their counterparts. According to the Journal of Sexually Transmitted Diseases, “nationally, syphilis diagnosis rates were 6.42 and 2.20 times higher among Black and Hispanic heterosexually active women compared with White heterosexually active women.” Rates of syphilis rose dramatically during the COVID-19 pandemic as well.
As a pregnant woman, what can I do to protect my unborn child and myself?
Here are three ways to prevent congenital syphilis.
1. Get Proper Prenatal Care
A lack of proper prenatal care can lead to missed screening opportunities that can prevent congenital syphilis. Appropriate screenings are a crucial part of any successful pregnancy. These should include screenings for sexually transmitted diseases.
The Lancet identified a lack of prenatal care as a contributor to adverse pregnancy outcomes in 2024.
“Inadequate access to prenatal care is associated with congenital syphilis across many jurisdictions,” according to a 2023 report published by Public Health Ontario. Nursing for Women’s Health confirmed that “Lack of prenatal care, poor access to prenatal care, and improper prenatal care all have contributed to cases of congenital syphilis.”
2. Get Tested …Again… And Again
In 2022, the CDC reported that “Lack of timely testing and adequate treatment during pregnancy contributed to 88% of cases of congenital syphilis.” Signs of syphilis are not obvious and can be masked by other conditions.
It is essential to request a test at every doctor’s visit. According to Frontiers in Public Health, “The extensive clinical manifestations of T. pallidum infection mimic those of many other diseases during pregnancy, which may lead to delayed diagnosis and serious consequences.”
Testing for syphilis once or twice during a pregnancy is not enough. A pregnant person must be tested before delivery. A 2020 article in IDCases stressed the importance of repeating the screening process to detect congenital syphilis. “For women at increased risk, repeat syphilis testing early in the third trimester and again at delivery in communities and populations with a high prevalence of syphilis is recommended,” and there is “a need for heightened clinical awareness of syphilis by providers,” according to IDCases.
Newborns at high risk should be tested, too, as children born with congenital syphilis can be asymptomatic. According to StatPearls, “If a mother tests serologically positive for syphilis, the newborn should receive a careful physical examination looking for any early signs or symptoms of congenital disease as well.”
If you can’t make it to be screened or rescreened, rapid tests are available for those with limited resources. These can be administered outside of traditional clinical environments.
The American College of Obstetricians and Gynecologists recommended an increase in syphilis screenings for pregnant people in a practice advisory they released in 2024.
3. Get Treated Before It’s Too Late
Syphilis can be effectively treated during pregnancy. A CDC Morbidity and Mortality Weekly Report from 2015 found that “maternal treatment with penicillin is 98% effective at preventing CS (congenital syphilis).” There are limited risks to treating the condition during pregnancy. Still, there are plenty of serious risks associated with leaving it untreated that threaten all of the major organs of a newborn.
The World Health Organization reports that “The risk of adverse outcomes to the fetus is minimal if a pregnant woman, infected with syphilis, receives testing and adequate treatment with benzathine penicillin, early in pregnancy – ideally before the second trimester.”
Frequent testing and appropriate treatment can change or save a life before it starts.
