- Overview of Infections in Newborns
- Sepsis in Newborns
- Hospital-Acquired Infections in Newborns
- Pneumonia in Newborns
- Bacterial Meningitis in Newborns
- Listeriosis in Newborns
- Conjunctivitis in Newborns
- Herpes Simplex Virus (HSV) Infection in Newborns
- Hepatitis B Virus (HBV) Infection in Newborns
- Cytomegalovirus (CMV) Infection in Newborns
- Rubella in Newborns
- Syphilis in Newborns
- Toxoplasmosis in Newborns
- Tuberculosis (TB) in Newborns
Syphilis is an infection caused by the bacteria Treponema pallidum. It causes serious problems in infants infected before birth.
Topic Resources
Syphilis is caused by bacteria.
Serious complications may develop during the pregnancy.
Newborns may have no symptoms or may develop serious symptoms and complications.
The diagnosis is typically based on blood tests of the newborn and mother.
Penicillin is used to treat the infection
(See also Overview of Infections in Newborns and Syphilis in adults.)
Syphilis is spread through sexual contact. However, if pregnant people are infected, their fetus can be infected before birth if the bacteria that cause syphilis cross the placenta (the organ that provides nourishment to the fetus). When a baby is born with syphilis, the infection is called congenital syphilis.
Congenital syphilis s widespread in the United States. In 2023, over 3,800 cases of congenital syphilis were reported, including 279 fetal deaths, stillbirths, and infant deaths. The infection is more common among infants who live in certain areas and among infants in certain racial and ethnic groups in the United States. The reason these groups are more affected is unclear, but it probably involves less access to high-quality health care in general and a decrease in public health activities for sexual health, including fewer public health nurses and field staff to test and follow up on infected people and see whether they are getting treated.
Worldwide in 2022, an estimated 700,000 cases of congenital syphilis were reported.
Pregnant people who have syphilis who do not receive treatment for it are at high risk of preterm birth and of their baby dying before (stillbirth) or shortly after birth.
Symptoms of Syphilis in Newborns
At birth, many newborns have no symptoms of syphilis. For newborns who do have symptoms, manifestations of congenital syphilis are classified as early or late.
Early congenital syphilis begins during the first 3 months of life. Large blisters or a flat copper-colored rash, which can be lighter or darker than surrounding skin, may develop on palms and soles. Raised bumps may develop around the nose and mouth and in the diaper area. Newborns may not grow well. They may have cracks around their mouth, or mucus, pus, or blood may run from their nose. Usually, their lymph nodes, liver, and spleen are enlarged. begins during the first 3 months of life. Large blisters or a flat copper-colored rash, which can be lighter or darker than surrounding skin, may develop on palms and soles. Raised bumps may develop around the nose and mouth and in the diaper area. Newborns may not grow well. They may have cracks around their mouth, or mucus, pus, or blood may run from their nose. Usually, their lymph nodes, liver, and spleen are enlarged.
Rarely, inflammation of the eyes or brain, seizures, meningitis, or intellectual disability occur.
Within the first 8 months of life, inflammation of bones and cartilage, especially of the long bones and ribs, may make it difficult for infants to move and may make the bones develop improperly.
Late congenital syphilis begins after 2 years of life. Sores may form in the nose and mouth and bones may grow abnormally. Eye problems may cause blindness and scarring of the cornea (the clear layer in front of the iris and pupil). Problems with development of the teeth and bones in the face also occur. Deafness may occur at any age.
Diagnosis of Syphilis in Newborns
Early congenital syphilis: Examination of material from the skin, the placenta, and/or the umbilical cord; blood tests of the mother and newborn; and possibly a spinal tap, other blood tests, and bone x-rays
Late congenital syphilis: Blood tests of the mother and newborn
Early congenital syphilis
The diagnosis of early congenital syphilis is usually based on the results of a pregnant person's blood test, which is routinely done early in pregnancy and repeated in the third trimester and at delivery in people with certain risk factors. If a pregnant person has syphilis, doctors will suspect her newborn does too. To determine whether a newborn born to an infected pregnant person has syphilis, doctors do a thorough physical examination and look for sores or a rash. If sores or a rash is present, doctors take samples and examine them under a microscope to look for the bacteria. They also test the placenta, umbilical cord, and the newborn's blood for syphilis.
Infants and young children up to age 2 who have symptoms of syphilis or who have a positive blood test should also have a spinal tap (lumbar puncture) to see if the infection has involved the brain. Doctors also do bone x-rays to look for bone changes that are characteristic of congenital syphilis.
Late congenital syphilis
Doctors suspect late congenital syphilis based on a physical examination and on the results of blood tests of the mother and newborn.
Doctors examine children and look for specific problems caused by the infection. The specific problems include inflammation of the eyes, deformities of the teeth, and deafness. The diagnosis of late congenital syphilis is confirmed in children who have these specific problems.
Treatment of Syphilis in Newborns
Penicillin
All people who have syphilis are treated with the antibiotic penicillin. While pregnant, infected people receive an injection (or a series of injections) of the antibiotic into a muscle (intramuscularly) or rarely into a vein (intravenously).
Newborns, infants, and children who are infected are given penicillin intravenously or intramuscularly.
Corticosteroid and atropine drops may be given for eye inflammation. Children who have hearing loss may benefit from Corticosteroid and atropine drops may be given for eye inflammation. Children who have hearing loss may benefit frompenicillin plus a corticosteroid taken by mouth, but this treatment does not always restore hearing.
Prevention of Syphilis in Newborns
Pregnant people should be routinely tested for syphilis during the first trimester and, if they live in a community with high rates of syphilis or have any risk factors for syphilis (for example, HIV infection or unsafe sex practices), they should be retested in the third trimester and at delivery.
In most cases, treatment with penicillin during pregnancy cures both the pregnant person and the fetus. However, treatment of a pregnant person less than 4 weeks before delivery may not fully treat the infection in the fetus.
