Congenital syphilis occurs when the bacterium responsible for the disease, the Treponema pallidum, passes from the mother to the baby during pregnancy or at the time of delivery, if the woman has lesions in the genital region caused by the bacteria.
Transmission from mother to baby can happen at any time during pregnancy, being more frequent in women who have never undergone treatment for syphilis or have not done the treatment correctly.
Congenital syphilis can result in changes in the baby’s development, premature birth, miscarriage, low birth weight or death of the baby when severely infected. Therefore, it is important for the woman to perform the prenatal examination and, if the diagnosis of syphilis is confirmed, start treatment according to the doctor’s guidance.
Symptoms of congenital syphilis may appear soon after birth, during or after the first 2 years of life. Thus, according to the age at which the symptoms start to appear, congenital syphilis can be classified as early, when the symptoms appear soon after birth or until 2 years old, and late, when they appear from 2 years old.
The main symptoms of early congenital syphilis are:
- Low weight;
- White and red spots with peeling skin;
- Wounds on the body;
- Liver enlargement;
- Yellowish skin;
- Breathing problems, with pneumonia possible;
In addition, the child may still be born with changes in vision or hearing, for example. In the case of late congenital syphilis, bone changes, learning difficulties and deformed upper teeth can be noticed.
How the diagnosis is made
The diagnosis of congenital syphilis is based on the symptoms presented and the result of laboratory tests of both the mother and the baby, however the diagnosis can be difficult because there may be positive results in babies who are not infected due to the passage of antibodies from the mother to the baby.
In addition, as most cases do not show symptoms before 3 months of age, it is difficult to confirm whether the test result is true. Thus, the need for treatment is indicated by the risk of the baby being infected with syphilis, which is determined by factors such as the mother’s treatment status, the result of the syphilis test and the physical examination done after birth.
How the treatment is done
The baby’s treatment varies according to the risk of syphilis infection after birth:
1. Very high risk of having syphilis
This risk is determined when the pregnant woman has not had treatment for syphilis, the baby’s physical examination is abnormal, or the baby’s syphilis test has VDRL values 4 times higher than the mother’s. In these cases, treatment is done in one of the following ways:
- Injection of 50,000 IU / Kg of aqueous crystalline penicillin every 12 hours for 7 days, followed by 50,000 IU of aqueous crystalline Penicillin every 8 hours between the 7th and 10th day;
- Injection of 50,000 IU / Kg of procaine Penicillin once a day for 10 days.
In either case, if you miss more than one day of treatment, it is recommended to start the injections again, to eliminate the risk of not fighting the bacteria correctly or getting infected again.
2. High risk of having syphilis
In this case, all babies that have a normal physical exam and a syphilis exam with a VDRL value equal to or less than 4 times that of the mother, but who were born to pregnant women who did not receive adequate treatment for syphilis or who started treatment less, are included. 4 weeks before delivery.
In these cases, in addition to the treatment options indicated above, another option can also be used, which consists of a single injection of 50,000 IU / Kg of benzathine Penicillin. However, this treatment can only be done if there is certainty that the physical examination does not have any changes and the baby can be accompanied by the pediatrician to do regular syphilis tests.
3. Low risk of having syphilis
Babies at low risk of having syphilis have a normal physical exam, a syphilis exam with a VDRL value equal to or less than 4 times the mother’s, and the pregnant woman started adequate treatment more than 4 weeks before delivery.
Usually, the treatment is done only with a single injection of 50,000 IU / kg of benzathine Penicillin, but the doctor can also choose not to do the injection and just keep monitoring the baby’s development with frequent syphilis tests, to assess if it really does. is infected, then undergoing treatment.
4. Very low risk of having syphilis
In this case, the baby has a normal physical examination, a syphilis test with a VDRL value equal to or less than that of the mother’s 4 times, and the pregnant woman underwent the appropriate treatment before becoming pregnant, presenting low VDRL values throughout the pregnancy.
Usually, treatment is not necessary for these babies, and should only be followed up with regular syphilis tests. In case it is not possible to maintain frequent monitoring, the doctor may recommend making a single injection of 50,000 IU / Kg of benzathine Penicillin.
How to avoid congenital syphilis
The only way to reduce the risk of passing syphilis to the baby is to start the mother’s treatment during the first half of pregnancy. Thus, it is important that the pregnant woman does all prenatal consultations, where important blood tests are done to identify possible infections that may affect the baby during pregnancy.
In addition, it is important that condoms are used in all sexual relations, in addition to the fact that the partner must also be treated for syphilis to avoid recontamination of the pregnant woman.