Syphilis is a sexually transmitted infection (STI) that can cause serious health problems without treatment. Infection develops in stages (primary, secondary, latent, and tertiary). Each stage can have different signs and symptoms.

Congenital syphilis (CS) is a disease that occurs when a mother with syphilis passes the infection on to her baby during pregnancy.

What is syphilis?

Syphilis is a sexually transmitted infection that can cause serious health problems if left untreated. It is a bacterial infection that spreads through sexual contact with someone who has the infection. If a person has or gets syphilis during pregnancy, it could lead to congenital syphilis in the infant after birth. Syphilis progresses through stages:

• The primary stage—painless sore at the site where syphilis entered the body. The sore usually lasts 3 to 6 weeks and heals regardless of whether you receive treatment.
• If left untreated, syphilis moves on to the secondary stage, symptoms include usually non-itchy skin rashes, fever, sore throat, fatigue. The rash can show up when your primary sore is healing or several weeks after the sore has healed.
• Without treatment, the infection moves on to the latent stage—a period when there are no visible signs or symptoms of infection, but the infection remains in the body.
• In its tertiary stage, syphilis can cause severe complications, including cardiovascular and neurological disorders. Tertiary syphilis is very serious and may occur 10–30 years after the infection began.

Congenital syphilis

When a pregnant person has syphilis, the infection can spread in utero before the child is born. This transmission of syphilis can occur at any stage of pregnancy and can result in serious consequences for the newborn. Congenital syphilis may lead to stillbirth, premature birth, low birth weight, and a range of serious health issues, including bone deformities, brain and nerve problems like blindness or deafness.

The impact of congenital syphilis highlights the importance of prenatal screening and early detection of syphilis in pregnant people. All pregnant people should receive testing for syphilis at their first prenatal visit. People who live in areas with high syphilis rates or who are at risk for getting syphilis during pregnancy should be retested at 28 weeks gestation and at time of delivery. Individuals at risk of getting syphilis during pregnancy include people who use illicit drugs, have other STIs during pregnancy, or have multiple sexual partners or a new partner, and those who have a partner with known STIs.

Prevention and screening

• The only way to completely avoid syphilis is to not have sexual contact.
• Consistent and correct use of condoms during sexual activity can reduce the risk of syphilis transmission.
• Routine screening for syphilis is recommended, especially for people at increased risk, including pregnant people. Ask your health care provider if you need to get screened for syphilis.
• Syphilis can be treated with antibiotics. Early detection of syphilis can lead to early treatment to prevent complications and reduce the spread of syphilis.

Treatment

Syphilis is curable with antibiotics. A single injection of long-acting Benzathine penicillin G can cure the early stages of syphilis. CDC recommends three doses of long-acting Benzathine penicillin G at weekly intervals for late latent syphilis and later stages of syphilis. Alternative therapies are available for people who have an allergy to penicillin but should not be used during pregnancy.

Talk with your health care provider about your situation and which treatment option is right for you.

Treatment will cure the infection and prevent further damage, but it will not repair damage already done.

As a soon-to-be mom, you are constantly being reminded of the things you should or shouldn’t do and what you should and shouldn’t worry about when it comes to protecting the health of your developing baby. While pregnancy fears are normal, the best way to handle them is by being informed and prepared. If you’ve already had your first prenatal visit, your doctor likely discussed syphilis testing with you. If not, read on to find out the most important facts about this disease, how it can affect your baby, and actions you can take to improve your chances of a healthy pregnancy and baby.

What is it?

Syphilis is a sexually transmitted disease that can cause very serious health problems if not treated. However, it is simple to prevent and can be cured with the antibiotic penicillin. When syphilis is not treated, it can eventually spread to the brain and nervous system or to the eye. This can cause problems like hearing loss, stroke, and blindness. Having syphilis can also increase a person’s risk for getting HIV or giving it to others. Syphilis can also be passed on to an unborn baby during pregnancy.

Congenital syphilis is the disease that occurs when a mother with syphilis passes the infection on to her baby during pregnancy.

How Congenital Syphilis Can Affect Your Baby’s Health

Up to 40% of babies born to women with untreated syphilis may be stillborn (a baby born dead) or die from the infection as a newborn. Infants born with congenital syphilis might have health problems like skin rashes, yellowing of the skin or whites of the eyes (jaundice), enlarged liver and spleen, or severe anemia (low blood count). Untreated babies that survive the newborn period can develop problems later on. They may be developmentally delayed or have seizures.

How concerned do I truly need to be?

Congenital syphilis should be on your radar because there has been a sharp increase in the number of babies born with the disease in the United States. In fact, cases of congenital syphilis have nearly quadrupled between 2015 and 2019. Public health professionals across the country are very concerned about this growing number of congenital syphilis cases.

What can I do to make sure my baby doesn’t get congenital syphilis?

If you are pregnant, here’s what you can do:

• Go to Your Doctor. If you think you may be pregnant, see a health care provider as soon as possible to be sure that you and your baby are healthy during your pregnancy. Prenatal care is important for every pregnancy. Even if you’ve been pregnant before, it’s important to ensure that THIS pregnancy is healthy. All pregnant women should be tested for syphilis, ideally at their first doctor visit. Make sure to ask your doctor about getting tested at your first visit.
• Ask for the Results of Your Syphilis Test. And if you test positive for syphilis during pregnancy, be sure to get treatment right away. Your doctor can treat you with medicine that is safe for both you and your unborn baby.
• Complete Follow-Up Visits with Your Doctor. Continue to visit your doctor regularly during your pregnancy to be sure that you and your baby stay healthy. If you learn that one of your sexual partners has or may have syphilis, tell your doctor right away so you and your partner can be treated, and your baby can be protected. Your doctor may need to retest you for syphilis at the beginning of your third trimester and at delivery, depending on how common syphilis infections are in the area that you live in. Ask your doctor if you should be retested during your pregnancy and at delivery.

CS can have major health impacts on your baby. How CS affects your baby’s health depends on how long you had syphilis and if — or when — you got treatment for the infection.

CS can cause:

• Miscarriage (losing the baby during pregnancy),
• Stillbirth (a baby born dead),
• Prematurity (a baby born early),
• Low birth weight, or
• Death shortly after birth.

Babies born to women with untreated syphilis may be stillborn, or die from the infection as a newborn.

For babies born with CS, CS can cause:

• Deformed bones,
• Severe anemia (low blood count),
• Enlarged liver and spleen,
• Jaundice (yellowing of the skin or eyes),
• Brain and nerve problems, like blindness or deafness,
• Meningitis, and
• Skin rashes.

No. It is possible that a baby with CS won’t have any symptoms at birth. But without treatment, the baby may develop serious problems. Usually, these health problems develop in the first few weeks after birth, but they can also happen years later.

Babies who do not get treatment for CS and develop symptoms later on can die from the infection. They may also be developmentally delayed or have seizures.

CS cases have more than tripled in recent years, with more than 2,000 cases reported in 2020 alone. This is the highest number reported in one year since 1994.

Public health professionals across the country are very concerned about the growing number of congenital syphilis cases in the United States. It is important to make sure you get tested for syphilis during your pregnancy.

Yes. All pregnant women should be tested for syphilis at the first prenatal visit (the first time you see your doctor for health care during pregnancy). If you don’t get tested at your first visit, make sure to ask your doctor about getting tested during a future checkup. Some women should be tested more than once during pregnancy. Talk with your doctor about the number of syphilis cases in your area and your risk for syphilis to determine if you should be tested again at the beginning of the third trimester, and again when your baby is born.

Keep in mind that you can have syphilis and not know it. Many people with syphilis do not have any symptoms. Also, syphilis symptoms may be very mild, or be similar to signs of other health problems. The only way to know for sure if you have syphilis is to get tested.

Yes. Syphilis can be treated and cured with antibiotics. If you test positive for syphilis during pregnancy, be sure to get treatment right away.

If you are diagnosed with and treated for syphilis, your doctor should do follow-up testing for at least one year to make sure that your treatment is working.

Your doctor must consider several factors to determine if your baby has CS. These factors will include the results of your syphilis blood test and, if you were diagnosed with syphilis, whether you received treatment for syphilis during your pregnancy. Your doctor may also want to test your baby’s blood, perform a physical exam of your baby, or do other tests, such as a spinal tap or an x-ray, to determine if your baby has CS.

CDC has specific recommendations for your healthcare provider on how to evaluate babies born to women who have positive syphilis tests during pregnancy.

Yes. There is treatment for CS. Babies who have CS need to be treated right away — or they can develop serious health problems. Depending on the results of your baby’s medical evaluation, he/she may need antibiotics in a hospital for 10 days. In some cases, only one injection of antibiotic is needed.

It’s also important that babies treated for CS get follow-up care to make sure that the treatment worked.

Your baby will not get CS if you do not have syphilis. There are two important things you can do to protect your baby from getting CS and the health problems associated with the infection:

• Get a syphilis test at your first prenatal visit.
• Reduce your risk of getting syphilis before and during your pregnancy.

Talk with your doctor about your risk for syphilis. Have an open and honest conversation about your sexual history and STD testing. Your doctor can give you the best advice on any testing and treatment that you may need.

Get a syphilis test at your first prenatal visit

If you are pregnant, and have syphilis, you can still reduce the risk of CS in your baby. Getting tested and treated for syphilis can prevent serious health complications in both mother and baby.

Prenatal care is essential to the overall health and wellness of you and your unborn child. The sooner you begin receiving medical care during pregnancy, the better the health outcomes will be for you and your unborn baby.

At your first prenatal visit, ask your doctor about getting tested for syphilis. It is important that you have an open and honest conversation with your doctor at this time. Discuss any new or unusual physical symptoms you may be experiencing, as well as any drugs/medicines you are using, and whether you have new or multiple sex partners. This information will allow your doctor to make the appropriate testing recommendations. Even if you have been tested for syphilis in the past, you should be tested again when you become pregnant.

If you test positive for syphilis, you will need to be treated right away. Do not wait for your next prenatal visit. It is also important that your sex partner(s) receive treatment. Having syphilis once does not protect you from getting it again. Even after you’ve been successfully treated, you can still be reinfected. For this reason you must continue to take actions that will reduce your risk of getting a new infection.

Reduce your risk of getting syphilis before and during your pregnancy

Preventing syphilis in women and their sex partners is the best way to prevent CS.

If you are sexually active, the following things can lower your chances of getting syphilis:

• Being in a long-term mutually monogamous relationship with a partner who has been tested for syphilis and does not have syphilis.
• Using latex condoms the right way every time you have sex. Although condoms can prevent transmission of syphilis by preventing contact with a sore, you should know that sometimes syphilis sores occur in areas not covered by a condom, and contact with these sores can still transmit syphilis.

Also, talk with your doctor about your risk for syphilis. Have an open and honest conversation with your doctor about your sexual history and about STD testing. Your doctor can give you the best advice on any testing and treatment that you may need.

Remember that it’s possible to get syphilis and not know it, because sometimes the infection causes no symptoms, only very mild symptoms, or symptoms that mimic other illnesses.