Congenital syphilis: A contemporary update on an ancient disease

Area of Science:

• Maternal-fetal medicine
• Infectious diseases
• Public health

Background:

• Congenital syphilis (CS) incidence has surged to a two-decade peak in the United States.
• A significant proportion of affected infants were born to mothers who received prenatal care, indicating gaps in current management.
• This trend underscores the critical need for enhanced provider education and stricter adherence to established guidelines.

Purpose of the Study:

• To review current recommendations for congenital syphilis screening, diagnosis, and treatment.
• To emphasize the importance of timely and appropriate management to improve neonatal outcomes.
• To address the challenges in diagnosing and treating syphilis in pregnant individuals.

Main Methods:

• Review of current Centers for Disease Control and Prevention (CDC) guidelines for syphilis diagnosis and treatment.
• Analysis of diagnostic algorithms (traditional and reverse) for syphilis.
• Discussion of treatment protocols, including recommended agents and timing.

Main Results:

• Screening for syphilis is recommended at the first prenatal visit and twice in the third trimester.
• Benzathine Penicillin G is the sole recommended treatment for syphilis during pregnancy.
• Early treatment (>30 days before delivery) is associated with optimal neonatal outcomes.

Conclusions:

• Adherence to screening and treatment guidelines is crucial to combat rising congenital syphilis rates.
• Understanding and applying diagnostic algorithms are essential for accurate diagnosis.
• Prenatal care alone does not prevent congenital syphilis; enhanced provider education and vigilance are necessary.