Syphilis - Neonatal Disorders

What is Syphilis?

Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. While it is primarily a concern in adults, it can have significant implications in pediatrics, particularly in the form of congenital syphilis.

How is Syphilis Transmitted to Children?

Children can acquire syphilis in two main ways:

Congenital Transmission: This occurs when an infected mother transmits the bacterium to her fetus through the placenta during pregnancy. The risk is highest in untreated mothers or those inadequately treated during pregnancy.
Perinatal or Postnatal Transmission: Though rare, syphilis can also be transmitted during delivery or through close contact with an infectious lesion.

What are the Symptoms of Congenital Syphilis?

The symptoms of congenital syphilis may vary depending on the stage of the disease:

Early Congenital Syphilis: Symptoms appear within the first two years of life and can include rash, fever, hepatosplenomegaly (enlarged liver and spleen), jaundice, anemia, and skeletal abnormalities.
Late Congenital Syphilis: Symptoms manifest after two years of age and can include saddle nose, Hutchinson teeth (notched incisors), saber shins (bowing of the tibia), and interstitial keratitis (inflammation of the cornea).

How is Syphilis Diagnosed in Children?

Diagnosis involves a combination of clinical evaluation and laboratory testing:

Clinical Evaluation: A thorough physical examination and medical history are essential.
Serologic Tests: These include non-treponemal tests (e.g., VDRL and RPR) and treponemal tests (e.g., FTA-ABS and TP-PA). Positive results must be confirmed with specific tests.
Direct Detection: Darkfield microscopy or PCR can detect the presence of Treponema pallidum in lesions or body fluids.

What is the Treatment for Syphilis in Children?

The mainstay of treatment for syphilis in children is antibiotic therapy, specifically penicillin. The regimen depends on the age of the child and the stage of the disease:

Infants: Newborns with congenital syphilis are treated with intravenous or intramuscular penicillin for 10-14 days.
Older Children: The treatment involves a single intramuscular injection of benzathine penicillin G. However, if the infection is late latent or of unknown duration, a prolonged course may be needed.

How Can Syphilis be Prevented in Children?

Prevention strategies focus on maternal health and include:

Screening: Pregnant women should be screened for syphilis during their first prenatal visit, and again in the third trimester and at delivery if at high risk.
Treatment: Prompt and adequate treatment of infected pregnant women with penicillin reduces the risk of transmission to the fetus.
Education: Raising awareness about the importance of prenatal care and safe sexual practices can help reduce the incidence of syphilis.

What are the Long-term Outcomes and Follow-up for Children with Syphilis?

With early diagnosis and appropriate treatment, the prognosis for children with congenital syphilis is generally favorable. However, untreated or inadequately treated syphilis can lead to severe complications, including neurological and developmental impairments. Regular follow-up is essential to monitor for any late manifestations and ensure that the treatment has been effective.