Maternal syphilis in Michigan: the challenge to prevent congenital syphilis

Syphilis has re-emerged as a significant public health problem for pregnant women and their babies in Michigan, US, and in many areas of the world. In the US over 50,000 cases of primary and secondary syphilis were reported to the Centers for Disease Control (CDC) in 1990. Due to the current epidemic of maternal syphilis in pregnancy in our city, we studied 253 cases of maternal syphilis over a one-year period. Our objective was to determine maternal risk factors during pregnancy predicting congenital infection. Women with high venereal disease research laboratory (VDRL) titres during pregnancy and unknown duration of disease had the highest incidence of delivering an infant with congenital syphilis. Even with treatment according to the current CDC guidelines there was a 27% incidence of congenital syphilis if disease duration was < 1 year and a 49% incidence of congenital syphilis for unknown duration of disease. Maternal syphilis during pregnancy was associated with significant neonatal morbidity and a preterm delivery incidence of 28%. The clinical evaluation, management, and current treatment guidelines are reviewed in this paper.