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Syphilis in Newborns

(Congenital Syphilis)


Brenda L. Tesini

, MD, University of Rochester School of Medicine and Dentistry

Reviewed/Revised Oct 2022 | Modified Nov 2022
Topic Resources
  • Syphilis is caused by bacteria.

  • Serious complications may develop during the pregnancy.

  • Newborns may have no symptoms or may develop serious symptoms and complications.

  • The diagnosis is typically based on blood tests of the newborn and mother.

  • Penicillin is used to treat the infection

Syphilis is spread through sexual contact. However, if a pregnant woman is infected, her fetus can be infected before birth if the bacteria that cause syphilis cross the placenta (the organ that provides nourishment to the fetus). When a baby is born with syphilis, the infection is called congenital syphilis.

Congenital syphilis has become much more common in the United States in recent years. Cases have increased by over 500% since 2010. Over 2,000 cases were reported in 2020, including at least 149 stillbirths and infant deaths. Congenital syphilis is also appearing in more geographic areas of the United States. The disease is more common among infants in certain racial and ethnic minority groups, particularly American Indian or Alaskan Native groups. The reason these groups are more affected is unclear, but it probably involves less access to high-quality health care in general and a decrease in public health activities for sexual health, including fewer public health nurses and field staff to follow up on infected people and see whether they are getting treated.

Symptoms of Syphilis in Newborns

Newborns may have no symptoms of syphilis, and some infected newborns never develop any problems throughout their life. For newborns who do have symptoms, manifestations of congenital syphilis are classified as early or late.

Early congenital syphilis begins during the first 3 months of life. Large blisters or a flat copper-colored rash may develop on palms and soles. Raised bumps may develop around the nose and mouth and in the diaper area. Newborns may not grow well. They may have cracks around their mouth, or mucus, pus, or blood may run from the nose. Usually, their lymph nodes, liver, and spleen are enlarged. Rarely, inflammation of the eyes or brain, seizures, meningitis, or intellectual disability occur. Within the first 8 months of life, inflammation of bones and cartilage, especially of the long bones and ribs, may make it difficult for infants to move and may make the bones develop improperly.

Late congenital syphilis begins after 2 years of life. Sores may form in the nose and mouth and bones may grow abnormally. Eye problems may cause blindness and scarring of the cornea (the clear layer in front of the iris and pupil). Problems with development of the teeth and bones in the face also occur. Deafness may occur at any age.

Diagnosis of Syphilis in Newborns

  • Early congenital syphilis: Examination of material from the skin, the placenta, and/or the umbilical cord; blood tests of the mother and newborn; and possibly a spinal tap, other blood tests, and bone x-rays

  • Late congenital syphilis: Blood tests of the mother and child

Early congenital syphilis

The diagnosis of early congenital syphilis is usually based on the results of a pregnant woman's blood test, which is routinely done early in pregnancy and often repeated in the third trimester and at delivery. If a pregnant woman has syphilis, doctors suspect her newborn does too. To determine whether a newborn born to an infected woman has syphilis, doctors do a thorough physical examination and look for sores or a rash. If sores or a rash is present, doctors take samples and examine them under a microscope to look for the bacteria. They also test the placenta, umbilical cord, and the newborn's blood for syphilis.

Infants and young children who have symptoms of syphilis or who have a positive blood test should also have a spinal tap Spinal Tap Diagnostic procedures may be needed to confirm a diagnosis suggested by the medical history and neurologic examination. Imaging tests commonly used to diagnose nervous system (neurologic) disorders... read more Spinal Tap (lumbar puncture) to see if the infection has involved the brain. Doctors also do bone x-rays to look for bone changes that are characteristic of congenital syphilis.

Late congenital syphilis

Doctors suspect late congenital syphilis based on a physical examination and on the results of blood tests of the mother and child.

Doctors examine children and look for specific problems caused by the infection. The specific problems include inflammation of the eyes, deformities of the teeth, and deafness. The diagnosis of late congenital syphilis is confirmed in children who have these specific problems.

Prevention of Syphilis in Newborns

Pregnant women should be routinely tested for syphilis during the first trimester and retested in the third trimester and at delivery if they live in a community with high rates of syphilis or have any risk factors for syphilis (for example, HIV infection or unsafe sex practices). In the United States, most states require first trimester screening, and many require the later testing too.

In 99% of cases, treatment with penicillin during pregnancy cures both the mother and the fetus. However, treatment of the mother less than 4 weeks before delivery may not eradicate the infection in the fetus.

Treatment of Syphilis in Newborns

  • Penicillin

All people who have syphilis are treated with the antibiotic penicillin. While pregnant, infected women receive an injection (or a series of injections) of the medication into a muscle (intramuscularly) or rarely into a vein (intravenously). Newborns, infants, and children who are infected are given penicillin intravenously or intramuscularly.

Corticosteroid and atropine drops may be given for eye inflammation. Children who have hearing loss may benefit from penicillin plus a corticosteroid taken by mouth.

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