Congenital Syphilis: A Threat to Neonatal Health.

Commentary

Introduction: Vertical transmission of syphilis can occur at any stage of pregnancy, regardless of the stage of the maternal disease. In Brazil, there is a constant increase in the number of cases of syphilis in pregnant women, congenital and acquired syphilis. Objective: To identify epidemiological aspects of cases of congenital and gestational syphilis in the State of Ceará. Methods: Retrospective descriptive study, with analysis of data on congenital and gestational syphilis in Ceará using the Notifiable Diseases Information System and dataSUS between 2013 and 2023. Results: During the studied period, 17,512 cases of syphilis in pregnant women were reported. Most women were diagnosed in the first trimester of pregnancy with 6,258 cases. Regarding the age group, 9,515 are adult women between 20 and 29 years old and regarding the level of education, 3,779 of the cases have incomplete 5th to 8th grade. Regarding race or color, 13,855 women declared themselves mixed race. The total number of cases of congenital syphilis was 12,000 cases, with diagnosis in children less than 7 days old in 98% of cases. Conclusion: Cases of gestational syphilis and congenital syphilis were highly prevalent in Ceará, affecting young, sexually active women with low education, predominantly of mixed race, who underwent prenatal care.

RESUMEN Objetivo: Realizar un reporte de 4 casos de hídrops fetal secundario a sífilis congénita y hacer una revisión de la literatura para responder la siguiente pregunta: ¿cuál es el esquema antibiótico utilizado en los casos de sífilis gestacional complicada con hídrops fetal? Materiales y métodos: Se presentan 4 casos de sífilis congénita con hídrops fetal. La edad materna varió entre 17 y 28 años, la edad gestacional al momento del diagnóstico estuvo entre 25 y 30 semanas, dos de ellas no habían iniciado control prenatal en ese momento. En tres casos se dio tratamiento para sífilis gestacional inmediatamente con penicilina cristalina entre 6 y 12 semanas antes del parto y se formuló tratamiento a la pareja con penicilina benzatínica. Respecto a los recién nacidos, dos de ellos no tenían infección activa o secuelas, se consideró que uno de ellos tenía sífilis congénita por títulos de prueba no treponémica. En uno de los casos, la paciente no alcanza a recibir tratamiento para la sífilis gestacional antes del parto, este recién nacido tenía signos de infección activa. Se hizo una revisión de la literatura en las bases de datos Medline, LILACS y google scholar; los términos de búsqueda fueron los siguientes: “hídrops fetal”, “lues”, “syphilis - prenatal diagnosis- ultrasound - penicilina - treatment”. Se buscaron reportes y series de casos o cohortes de recién nacidos con sífilis gestacional con hídrops fetalis. Se extrajo información sobre la madre y el recién nacido respecto al tratamiento.Resultados: Se identificaron 119 artículos, de estos 13 cumplieron con los criterios de inclusión, tres fueron descartados por no tener acceso al texto completo. Se incluyeron diez estudios de un total de 16 casos reportados con diagnóstico prenatal de hídrops fetal secundarios a infección congénita. De ellos, tres presentaron anemia fetal severa y requirieron transfusión intrauterina; 5 casos recibieron tratamiento intrauterino con penicilina. En cuatro casos la madre recibió penicilina benzatínica intramuscular por 3 semanas, uno recibió además penicilina cristalina endovenosa por 13 días, otro recibió penicilina cristalina endovenosa por 14 días. Un total de 11 casos no recibieron tratamiento durante la gestación; 6 de los 16 casos (37,5%) presentaron muerte perinatal. Conclusión: El retraso en acudir al control prenatal y la tardanza del diagnóstico y tratamiento de la sífilis gestacional son causas importantes de la persistencia de la sífilis congénita. Se requieren estudios aleatorizados para determinar el mejor tratamiento del feto con sífilis congénita en los 30 días previos al parto y del feto con compromiso sistémico durante la segunda mitad de la gestación.

Background The yearly number of congenital syphilis (CS) cases in California is at its highest point since 1950. We explored how efforts in California to 1) reduce syphilis cases; and 2) increase adequate syphilis treatment among infected pregnant persons could impact CS case projections through 2030. Yearly projected incidence by scenario comparing the baseline scenario to a 10% reduction in infections, 10% increase in treatment adequacy, and both interventions combined Methods We developed a scenario modeling framework to project CS incidence between 2023–2030 using California 2015–2022 surveillance data on CS cases and female syphilis cases of childbearing age (15–44 years). We compared a baseline scenario where existing trends continued without additional interventions to scenarios that considered 1) the impact of an absolute reduction of 2–10% in the rate of female syphilis cases per year; and 2) a 2–10% increase in the proportion of pregnant persons adequately treated for syphilis. Results A reduction in the absolute rate of female syphilis cases by 2–10% led to an 8–31% decrease in cumulative CS cases between 2023–2030. Increasing the proportion of pregnant persons adequately treated for syphilis by 2–10% over baseline led to a 1–8% decrease in cumulative CS cases. Combining both scenarios resulted in an 8–37% reduction in cumulative cases. Conclusion This model shows that to reduce CS case incidence in California, the most important upstream intervention is to reduce the rate of syphilis among females. To this end, syphilis screening and treatment among those who infect females must be improved. Additionally, even assuming no changes in syphilis incidence in females, CS cases could be reduced to a lesser extent by increasing the proportion of pregnant persons with syphilis who are adequately treated above current rates. The results of this study can inform syphilis screening and treatment recommendations, and the magnitude of future CS case reduction will depend on intervention scope and implementation. Disclosures All Authors: No reported disclosures

Syphilis is considered a serious public health problem in Brazil and worldwide. The disease is especially worrying during pregnancy, as the mother can transmit the infection to her fetus, causing congenital syphilis. In this context, few articles have established a causal relationship between the growth in the number of cases of gestational and congenital syphilis in the Xingu Region and the construction of the Belo Monte Hydroelectric Plant. Objective: This study aims to analyze the influence of the intense migratory flow resulting from the construction of the Belo Monte Hydroelectric Power Plant on the cases of congenital syphilis. Methodology: This is an ecological study of congenital syphilis reported in the Xingu Region from January 2007 to 2019, using data obtained from the Information System of Notification Grievances. Results: It was found that there was an influence of the construction of the Belo Monte hydroelectric plant on the number of cases of congenital syphilis in the region.294 cases of congenital syphilis were reported. The most affected pregnant women were between 16 and 20 years old, were brown, had incomplete primary education and lived in the urban area. The study revealed numerous shortcomings in prenatal care provided in the Xingu Region.

BackgroundSyphilis is a major public health problem in many regions of China, with increases in congenital syphilis (CS) cases causing particular concern. Precisely determining the extent of CS burden has...

Introduction: Syphilis is an infectious disease that can cause congenital syphilis when it affects pregnant women, resulting in malformation of the fetus, miscarriage, or fetal death. Unlike many neonatal infections, congenital syphilis is considered a preventable perinatal cause, because it can be diagnosed and treated early during pregnancy. Objective: To analyze the reports of cases of gestational syphilis and congenital syphilis registered in Foz do Iguaçu City, Paraná State, between 2014 and 2018. Methods: This is a time-series study on the trend of cases recorded in the Notification Diseases Information System. The simple linear regression model was adopted to verify the trend of deaths in the analyzed period. Results: A total of 324 reports of gestational syphilis and 137 cases of congenital syphilis were evidenced in the study period. Regarding cases of gestational syphilis, 45.9% were diagnosed during the first trimester of pregnancy, 74.6% were treated with penicillin, and 24.3% were classified as primary syphilis. Roughly 88.3% of cases of congenital syphilis were reported in children under the age of 7 days. A significant increase in the rate of detection of gestational syphilis was observed, representing an increase of 4.0 times (p=0.004) in the years analyzed, and the risk of congenital syphilis increased 5.8 times (p=0.003) in the same period. Conclusion: The magnitude of gestational and congenital syphilis is a warning that indicates the need for actions and strategies to reduce cases of gestational syphilis and vertical transmission of syphilis.

Introduction: Syphilis is still a worldwide problem; with approximately 12 million people infected every year. Over the last decade, Brazil had an increment in the number of cases. The year 2016 reported 37,436 cases of syphilis in pregnant women and 20,474 cases of congenital syphilis, with 185 deaths. The Southeast region reached the highest numbers, especially in the state of Espírito Santo with high rates in pregnant women, being the third highest incidence rate in the country with 10.4 cases/1,000 live births, above the national average of 6.8 cases/1,000 live births. Objective: Describe the therapeutic treatment of children affected with congenital syphilis as well as the clinical, radiological and laboratory changes associated to this disease. Methods: Retrospective, descriptive, exploratory, quantitative study, based on 204 notification forms of congenital syphilis from January 2016 to December 2017. Results: The findings showed that 88.7% of the puerperal women performed prenatal care. Regarding newborns, 85.3% were asymptomatic. When analyzing the therapeutic regimen instituted, 22.5% used procaine Penicillin G, 22.5% crystalline Penicillin G and 20.6% benzathine Penicillin G. Conclusion: The treatment instituted by this philanthropic maternity for newborns with congenital syphilis is in line with the guidelines proposed by the Ministry of Health. The clinical symptoms do not represent a frequent finding during the neonatal period, however, they can occur later.

To describe the epidemiologic profile of congenital syphilis in Mexico between 1990 and 2009. The database of the General Direction of Epidemiology at the Ministry of Health in Mexico about congenital syphilis was reviewed. Data corresponding to the period between 1990 and 2009 were analyzed in every state of the Mexican republic. A total of 1717 cases of congenital syphilis were reported during the study period. A 16.6% increase was observed between 2005 and 2009 and the quinquennium between 2000 and 2004. A trend toward increase in the incidence of congenital syphilis was observed with 2.9 new cases for each 100,000 babies born alive. The states that displayed significant positive trends were as follows: Baja California, Colima, Chihuahua, Jalisco, Nayarit, Sinaloa, and Zacatecas. An increase in the number of cases of congenital syphilis is observed; the northern states are the ones that contribute the most to the statistics. There is a real need to refine the epidemiologic operations to detect and treat the cases of maternal and congenital syphilis in the country.

Introduction: Syphilis is an infection with increasing incidence in Brazilian regions, and the congenital form is liable to lead to cerebral palsy and musculoskeletal deformity. The objective of this study was to analyze the prevalence of congenital syphilis in the State of Rio Grande do Norte, Brazil.
 Methods: An exploratory and retrospective study was performed from 2015 to 2017. Public domain data and unrestricted access were used in the DATASUS computer department through the TABNET application. The following variables were collected: age range, clinical evolution (congenital syphilis late, late congenital syphilis, stillbirth / syphilis abortion, ignored / blank, discarded; live birth), mother's schooling, performed prenatal and residence zone.
 Results: In Brazil, there were 75,733 cases, whereas in the State of Rio Grande do Norte there were 1,436 cases of congenital syphilis, out of which a greater number of confirmed cases affected age group of 0-6 days (97.6%). The highest number of cases was observed in the city of Natal (75.8%), followed by Mossoró (7.8%) and Parnamirim (5.7%).
 Conclusion: The study shows that the incidence of congenital syphilis occurs predominantly in incomplete elementary schooling and in the urban area. It was also verified that the diagnosis of most cases of congenital syphilis occurred in the age group up to 6 days of life, which contributes to the rates of evolution with the living child. In addition, a greater number of confirmed cases of congenital syphilis were observed, and prenatal care was performed, indicating a serious failure in care.

Is current therapy for maternal syphilis inadequatefor established fetal infection?

Congenital syphilis has been diagnosed very seldom in ancient populations. The case that we examined comes from San Jeronimo's Church (17th and 18th centuries AD; Mexico City). Coffin 43 contained an incomplete skeleton of an approximately 2-year-old infant. The pathological lesions of this skeleton include bilateral osteochondritis, diaphyseal osteomyelitis, and osteitis and/or periostitis on the long bones. The radiographic appearance depicts symmetrical osteomyelitic foci, particularly at the proximal extremity of both tibiae (Wimberger's sign). The skull exhibits hydrocephaly and periosteal changes on the vault, and the unerupted upper incisors evince dental hypoplasia and other pathological alterations reminiscent of Hutchinson's incisors. All these features strongly suggest a case of early congenital syphilis.

Congenital syphilis is a potentially serious pathology affecting newborns of infected mothers. Even one case of congenital syphilis is a sentinel public health event, since timely diagnosis and treatment of syphilis infected pregnant woman should prevent transmission almost entirely. Here, we are reporting a case of early symptomatic congenital syphilis presented with severe desquamating papulosquamous lesions over multiple body parts along with erosive lesions around oral cavity and nostrils.

Congenital syphilis is a potentially serious pathology affecting newborns of infected mothers. Even one case of congenital syphilis is a sentinel public health event, since timely diagnosis and treatment of syphilis infected pregnant woman should prevent transmission almost entirely. Here, we are reporting a case of early symptomatic congenital syphilis presented with severe desquamating papulosquamous lesions over multiple body parts along with erosive lesions around oral cavity and nostrils.

Background and Objectives: Congenital syphilis remains a significant global health concern, with severe morbidity and mortality if undiagnosed and untreated. Although many infants appear asymptomatic at birth, subtle clinical signs-including bullous lesions (congenital bullous syphilis, also known as pemphigus syphiliticus)-may facilitate early detection. Recognizing this rare manifestation is crucial for timely intervention, reducing serious outcomes. Materials and Methods: We systematically reviewed Medline (PubMed), Embase, and the Cochrane Central Register of Controlled Trials from inception to December 2024 for cases of congenital bullous syphilis, also known as pemphigus syphiliticus. We extracted demographic, clinical, laboratory, radiological, treatment, and outcome data. Additionally, we included clinical information from a newly documented case of congenital bullous syphilis managed in our center. Results: Twenty-four cases of congenital syphilis with bullous lesions were identified, twenty with sufficient detail for analysis. Patients presented three distinct clinical patterns: confined palmoplantar lesions, acrally distributed lesions, and diffuse bullous-erosive involvement. Despite variable severity, cutaneous manifestations provided a key diagnostic clue. Nontreponemal and treponemal serologic tests were central to diagnosis, supported by maternal screening and imaging. Intravenous penicillin G was the most frequently employed therapy. While most infants achieved remission, severe respiratory involvement was associated with mortality. Our new case aligned with these findings, demonstrating full resolution after appropriate antibiotic therapy. Conclusions: Bullous syphilis, though rare, is an important early sign of congenital syphilis. Prompt recognition and diagnosis-enabled by diligent maternal screening, targeted neonatal testing, and careful clinical examination-are essential to initiate timely penicillin therapy and prevent severe complications or death. This review underscores the need for heightened clinical vigilance and adherence to established guidelines for syphilis screening and treatment during pregnancy, ultimately improving neonatal outcomes.