Syphilis Complicating Pregnancy and Congenital Syphilis

Abstract

Congenital syphilis, first described by Gaspar Torella in 1497, results primarily from the transplacental passage of Treponema pallidum and continues to cause major negative consequences worldwide. 1After a steady decline in U.S. cases of primary and secondary syphilis after 1990, which led to hopes of its elimination, rates hit a nadir in 2001.Unfortunately, the rates have subsequently increased among men and women of reproductive age, as well as infants, and in 2021, the rate of congenital syphilis in the United States was the highest it has been in nearly 30 years. 2 EPIDEMIOLOGY Syphilis, like many sexually transmitted infections (STIs), disproportionately affects populations with limited access to health care. [2][3]3][4][5] The annual U.S. rates of primary and secondary syphilis among Native American and Alaskan Native persons, Native Hawaiian and Pacific Islanders, and Black women, as compared with White women, have increased over the past 5 years by factors of 8, 4, and 3.5, respectively. 2,3,5Along with the rise in cases of syphilis among persons of reproductive age, 2 cases of congenital syphilis increased by 754.8% from 2012 to 2021; currently, 1 in every 1300 live births is affected. 2Since these data reflect only identified and reported cases of syphilis, they probably represent an underestimate of the incidence. 2,6,7Cases of syphilis in late infancy and early childhood among international adoptees or refugees have also been increasing. 8Escalating rates of congenital syphilis predated the coronavirus disease 2019 (Covid-19) pandemic but increased further as public health programs shifted to respond to Covid-19. 2,5,[9][10]0][11][12][13] The effect of untreated syphilis on maternal and neonatal health outcomes is profound, with mother-to-child transmission of syphilis estimated to cost $3.6 million in disability-adjusted life-years and $309 million in medical costs globally.

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