Is Congenital Syphilis Still a Problem?—A 20-Year Retrospective Study from a Northern Portuguese Level II Hospital

Abstract

Objective The incidence of syphilis and congenital syphilis has increased in recent years according to European and United States of America official data: indeed, 2019 was the second consecutive year when the number of reported cases has increased. Syphilis is a venereal disease caused by a spirochete, Treponema pallidum. Congenital syphilis is a consequence of maternal T. palidum transmission to a fetus at any stage of maternal disease, via a transplacental pathway or during labor.

Methods To investigate the incidence, characteristics, and temporal evolution of neonates with suspected congenital syphilis (proven, possible, or less likely and unlikely) or born from mothers with treated and untreated latent syphilis, we designed a retrospective and descriptive study of hospitalized neonates between 2001 and 2020, in a level II hospital located in the northern Portuguese countryside.

Results We report a total of 22 neonates, 50% female. Pregnancy was unsupervised or had inadequate surveillance in 36% of cases (n = 8), in 32% (n = 7) syphilis was not treated, and in 14% (n = 3) it was inadequately treated. All neonates studied with suspected congenital syphilis were asymptomatic and all were treated with penicillin for a mean duration of 11 days. Of the 22 neonates with suspected congenital syphilis, 20 had possible congenital infection. Social vulnerability was also an important factor present in our study group.

Conclusion Despite being an ancient disease, congenital syphilis is still a concern mostly due to the lack of adequate pregnancy surveillance and maternal/partner diagnosis and treatment.

Keywords

congenital syphilis - risk factors - hospitalization - treatment

Publication History

Received: 24 April 2023

Accepted: 24 November 2023

Article published online:
29 December 2023

• References

• 1 ECDC. Congenital syphilis—annual epidemiological report for 2018. 2020 Accessed Month DD, 2020 at: https://www.ecdc.europa.eu/en/publications-data/congenital-syphilis-annual-epidemiological-report-2018
• 2 Keuning MW, Kamp GA, Schonenberg-Meinema D, Dorigo-Zetsma JW, van Zuiden JM, Pajkrt D. Congenital syphilis, the great imitator-case report and review. Lancet Infect Dis 2020; 20 (07) e173-e179
• 3 Radolf JD, Deka RK, Anand A, Šmajs D, Norgard MV, Yang XF. Treponema pallidum, the syphilis spirochete: making a living as a stealth pathogen. Nat Rev Microbiol 2016; 14 (12) 744-759
• 4 Kimberlin DW, Brady MT, Jackson MA, Long SS. Red Book: 2018 Report of the Committee on Infectious Diseases. 31th ed. American Academy of Pediatrics; 2018
• 5 Galvis AE, Arrieta A. Congenital syphilis: a U.S. perspective. Children (Basel) 2020; 7 (11) 203
• 6 Bezerra MLMB, Fernandes FECV, de Oliveira Nunes JP, de Araújo Baltar SLSM, Randau KP. Congenital syphilis as a measure of maternal and child healthcare, Brazil. Emerg Infect Dis 2019; 25 (08) 1469-1476
• 7 Murali MV, Nirmala C, Rao JV. Symptomatic early congenital syphilis: a common but forgotten disease. Case Rep Pediatr 2012; 2012: 934634
• 8 Cooper JM, Sánchez PJ. Congenital syphilis. Semin Perinatol 2018; 42 (03) 176-184
• 9 Theel ES, Katz SS, Pillay A. Molecular and direct detection tests for treponema pallidum subspecies pallidum: a review of the literature, 1964-2017. Clin Infect Dis 2020; 71 (Suppl. 01) S4-S12
• 10 Rac MWF, Stafford IA, Eppes CS. Congenital syphilis: a contemporary update on an ancient disease. Prenat Diagn 2020; 40 (13) 1703-1714
• 11 DGS. Elementos estatísticos saúde 2011/2012. 2012
• 12 INE. Estatísticas da Saúde—2017. 2019
• 13 Zeitlin J. Better statistics for better health
• 14 Santo RE, Salgado C, Valente S, Saldanha J. Qualidade dos registos no Boletim de Saúde da Grávida: a importância para o neonatologista. Nascer e Crescer—Birth Growth Med J. 2017; 26 (01) 11-20
• 15 Ortiz-Lopez N, Diez M, Diaz O, Simon F, Diaz A. Epidemiological surveillance of congenital syphilis in Spain, 2000-2010. Pediatr Infect Dis J 2012; 31 (09) 988-990
• 16 Umapathi KK, Thavamani A, Chotikanatis K. Incidence trends, risk factors, mortality and healthcare utilization in congenital syphilis-related hospitalizations in the United States: a nationwide population analysis. Pediatr Infect Dis J 2019; 38 (11) 1126-1130
• 17 Slutsker JS, Hennessy RR, Schillinger JA. Factors contributing to congenital syphilis cases—New York City, 2010-2016. MMWR Morb Mortal Wkly Rep 2018; 67 (39) 1088-1093
• 18 Garcia LN, Destito Solján A, Moroni S. et al. Congenital syphilis in Argentina: experience in a pediatric hospital. PLoS Negl Trop Dis 2021; 15 (01) e0009010-e0009010
• 19 DiOrio D, Kroeger K, Ross A. Social vulnerability in congenital syphilis case mothers: qualitative assessment of cases in Indiana, 2014 to 2016. Sex Transm Dis 2018; 45 (07) 447-451
• 20 Salomè S, Cambriglia MD, Scarano SM. et al. Congenital syphilis in the twenty-first century: an area-based study. Eur J Pediatr 2023; 182 (01) 41-51
• 21 Heston S, Arnold S. Syphilis in children. Infect Dis Clin North Am 2018; 32 (01) 129-144
• 22 Woods CR. Congenital syphilis-persisting pestilence. Pediatr Infect Dis J 2009; 28 (06) 536-537
• 23 Chau J, Atashband S, Chang E, Westerberg BD, Kozak FK. A systematic review of pediatric sensorineural hearing loss in congenital syphilis. Int J Pediatr Otorhinolaryngol 2009; 73 (06) 787-792
• 24 Stamm LV. Hope for new antibiotics for syphilis treatment. EBioMedicine 2021; 66: 103320