Congenital Syphilis: Strategies for Prevention

Once nearly eradicated, rates of syphilis among pregnant people have increased over 200% and rates of congenital syphilis have increased over 750% since the 2010s. Syphilis disproportionately affects historically marginalized populations, including racial and ethnic minorities, and those with barriers to prenatal care. Syphilis is caused by the spirochete Treponema pallidum and is spread through sexual contact or through vertical transmission in utero. Syphilis during pregnancy can lead to negative outcomes for the pregnant person, adverse pregnancy outcomes, and congenital syphilis for the child. Manifestations of syphilis vary widely and are divided into primary, secondary, latent, and tertiary disease, earning it the nickname the "great imitator." In utero transmission of syphilis can lead to congenital syphilis, which can result in neurodevelopmental and physical disabilities. Penicillin is the antibiotic recommended for the treatment of syphilis. Early treatment of syphilis during pregnancy improves outcomes and can prevent congenital syphilis. Treatment of syphilis after birth cures the infection and also improves outcomes but does not reverse damage already done. Previously, syphilis testing during pregnancy varied based on the identification of risk factors for syphilis. Universal testing for syphilis during pregnancy is now recommended, including recently updated recommendations for testing at birth. Two case examples of syphilis are provided as examples to demonstrate the impact of screening and treatment during pregnancy on the risk of congenital syphilis. A health-equity informed approach to interventions to decrease syphilis during pregnancy and congenital syphilis is emphasized.