Congenital syphilis is transmitted from mother to child during pregnancy or delivery. It can cause serious complications in fetuses and newborns like stillbirth, premature delivery, or symptoms affecting the liver, skin, bones and nervous system. While rates of congenital syphilis have decreased in many places, some countries like Timor-Leste still experience underreporting due to lack of antenatal screening and treatment. Diagnosis involves clinical signs, serology tests, and examinations of tissues affected like the liver, bones, eyes and spinal fluid. Treatment requires penicillin therapy for infants born to mothers with syphilis during pregnancy.

1. Congenital syphilis

2. Definition
Syphilis is a chronic systemic sexually or vertically
(mother to child) transmitted infection

3. Case Definition
require only one of two criteria:
 physical, laboratory, or radiographic signs of
congenital syphilis (confirmed/highly probable
congenital syphilis),
 or born to a mother with untreated, inadequately,
or suboptimally treated syphilis (presumed
congenital syphilis

4. epidemiology
 WHO 2018 STI surveillance, per 100.000 live births
decreased from 539 in 2012 to 473 in 2016.
 In the US, increased from 9.2 cases per 100.000 live births
in 2013 to 23.2 cases per 100.000 live births in 2017.
 In timor Leste there is no routine screening for pregnant
woman during antenatal care, and due to lack of
awareness, most stillbirth and preterm birth are not tested
for siphylis.
 In timor leste estimate that many cases are underreported.

5. TRANSMISSION
transplacental
occasionally, direct contact with an infectious
lesions during birth.

6. PATHOGENESIS
 T. pallidum is liberated directly into the circulation of the
fetus, resulting in spirochetemia with widespread
dissemination to almost all organs.
 clinical manifestations result from the inflammatory
response.
 The organs most frequently and severely involved are
bones, liver, pancreas, intestine, kidney, and spleen.
 Infection can manifest in the fetus, the newborn or later in
childhood (if the infant is not treated)

7. Clinical Manifestations
• Early infection, untreated: miscarriage, stillbirth, neonatal death,
IUGR, premature delivery.
Think of syphilis in every stillbirth
Approximately 60 to 90 percent are asymptomatic at birth.

8. Early clinical syphilis
Placenta and umbilical cord
Hepatomegaly
Rhinitis
Rash
Generalized lymphadenopathy

9. Placenta and umbilical cord
often large, thick, and pale.
The umbilical cord is edematous and may
resemble a "barber's pole" with spiral stripes of
red and light blue discoloration alternating with
streaks of chalky white. It may be significantly
inflamed with an abscess-like foci of necrosis
within Wharton jelly, centered around the
umbilical vessels (necrotizing funisitis)

11. Hepatomegaly
occurs in almost all infants with congenital
syphilis.
Hepatomegaly may or may not be associated
with splenomegaly, but isolated splenomegaly
does not occur.
Hepatomegaly is associated with jaundice and
cholestasis.
Liver dysfunction generally resolves slowly,
even after adequate therapy.

12. Rhinitis ("snuffles")
develops during the first week of life and rarely
after the third month.
The nasal discharge is white and may be bloody
(secondary to mucosal erosion) or purulent if
there is secondary bacterial infection. It is more
severe and persistent than the nasal discharge of
the common cold
contains spirochetes, is contagious, and can
transmit infection by direct contact.

14. Rash
 appears one to two weeks after the rhinitis.
 It is maculopapular and consists of small, initially red or pink spots.
The lesions may occur anywhere, but are more prominent on the
back, buttocks, posterior thighs, and soles .
 The rash generally progresses over one to three weeks, followed by
desquamation and crusting. As it fades, the lesions become dusky
red or copper-colored, and the pigmentation may persist.
 If present at birth, the rash may be widely disseminated and bullous
(pemphigus syphiliticus). Ulcerative lesions and bullous fluid contain
spirochetes, are contagious, and can transmit infection by direct
contact.

16. Pigmented lesions on the soles of
an infant with congenital syphilis.

17. approximately 40% of infants born to women
with untreated syphilis during pregnancy.
chronic granulomatous inflammation of bone,
teeth, and central nervous system
Hutchinson teeth, Saddle nose, unilateral or
bilateral interstitial keratitis, Clutton joint.
LATE CONGENITAL SYPHILIS

18. Diagnosis
Diagnosis of syphilis in TL is currently based on
– Clinical features
– Serology (syphilis rapid test (TTPA)
 Hematologic studies:
Anemia, Thrombocytopenia, Leucopenia or leukocytosis
 CSF
 CXR, long bone XRays, abdominal USG, LFT, ophthalmologic
examination, Auditory brainstem response.

19. TREATMENT
All babies born to mothers who had syphilis in
pregnancy will require penicillin treatment
The type of penicillin (IM benzathine vs IV
benzyl)