Congenital syphilis is uncommon in the UK largely due to the success of screening in early pregnancy and effective management of maternal infection. There are approximately 10 cases of congenital syphilis reported annually resulting mainly from:
• Missed or declined antenatal screening.
• New maternal infection following a negative screen at booking.
Although fetal infection can occur in any trimester it usually does so later in pregnancy and congenital syphilis is more likely to occur when the woman has primary or secondary syphilis and is treated less than 30 days before delivery.
Prompt treatment of the pregnant woman is extremely effective in preventing congenital syphilis. Any woman who screens positive for syphilis should be seen within 10 working days of her positive result by the screening team who will coordinate her care throughout her pregnancy in birth.
Women with proven syphilis infection will need treatment regardless of whether the disease is latent or not. Additionally treatment is required for cases of previously diagnosed infection where adequate past treatment cannot be ascertained.
Maternal referral to fetal medicine is recommended in cases of syphilis treated after 26 weeks' gestation. As congenital syphilis may be suggested by ultrasound scan detection of non-immune hydrops or hepatosplenomegaly.
Untreated syphilis in pregnancy is associated with adverse fetal outcomes:
• Spontaneous abortion
• Late-term still birth
• Prematurity
• Low birth weight
Placental infection and the reduction in blood flow to the fetus are the most common causes of fetal death in utero. All neonates born to mothers treated for syphilis in pregnancy require clinical evaluation.
It is important to note that most neonates with congenital syphilis appear normal at birth making the disease very difficult to diagnose. Appropriate follow-up and care of the baby arranged.
This highlights the need to offer and recommend screening early in every pregnancy and emphasise the importance of safe sex throughout pregnancy. All women who declined screening should be directly referred to the screening team for further discussion.
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