Health Alert Template for Congenital Syphilis

Customizable template

Summary

• As of [date], [number] cases of congenital syphilis have been diagnosed in [jurisdiction]. Alternatively: As of [date], [number] cases of primary and secondary syphilis have been diagnosed in women under 40 years old, an increase of [percentage] since [date].
• [Insert local screening recommendations or changes in screening recommendations here.] No infant should leave the hospital without the parent's serological status having been documented at least once during pregnancy.
• Treatment: Pregnant people with syphilis should be treated with one to three shots of benzathine penicillin G, 2.4 million units IM depending on the stage of syphilis (see CDC treatment guidelines). Penicillin G is the only known effective antimicrobial for preventing maternal transmission to the fetus and treating fetal infection. Pregnant people who have a history of penicillin allergy must be desensitized and treated with penicillin.
• Congenital syphilis should be considered in all stillbirths after 20 weeks, and in infants of a parent with evidence of syphilis infection during pregnancy, especially if syphilis is newly acquired during pregnancy. Infants with an infection can be asymptomatic at birth, but can develop serious symptoms in the neonatal period or later in life.
• Please report all information related to clinical and laboratory reports on suspected or probable congenital syphilis cases to [name] at [phone] or [email].

Background

Congenital syphilis rates in the U.S. started to increase in 2012 and continued to rise with an increase of almost 31% from 2021 to 2022. [NOTE: The jurisdiction can insert local epidemiology data here.]

Symptoms

Treponema pallidum causes syphilis and can present in several stages. The chancre of primary syphilis is painless and may not be noted by those with infections as it resolves even without treatment. Most patients who seek care do so with secondary syphilis whose symptoms include a rash that may involve the palms and soles, condyloma lata, and lymphadenopathy. Left untreated, syphilis can cause cardiac system abnormalities and neurological symptoms in later stages.

A pregnant person can transmit syphilis to their child during any stage of syphilis and any trimester of pregnancy. However, the risk of transmission is highest if they have a recent infection. Syphilis infection during pregnancy increases adverse pregnancy outcomes including preterm birth and stillbirth. Up to 40% of babies born to someone with untreated syphilis (if infected within four years prior to delivery) will be stillborn or die in infancy. Congenital syphilis can lead to newborn and childhood illness including:

• hydrops fetalis.
• hepatosplenomegaly.
• rashes.
• fevers.
• failure to thrive.
• deformity of the face, teeth, and bones.
• blindness.
• deafness.

Recommendations

Screening

• All pregnant people residing in [jurisdiction] should be screened for syphilis. [NOTE: Insert any specific local screening recommendations.]
• Someone who experiences a stillbirth after 20 weeks of pregnancy should be tested for syphilis.
• Infants should not be discharged from the hospital unless the parent was tested for syphilis at least once during pregnancy and preferably, again at delivery.

Diagnosis and treatment

Syphilis during pregnancy

• Two tests are required to diagnose syphilis, a non-treponemal assay (i.e., Venereal Disease Research Laboratory [VDRL] or Rapid Plasma Reagin [RPR]) and a confirmatory treponemal test (i.e., fluorescent treponemal antibody absorbed [FTA-ABS] tests, the pallidum passive particle agglutination [TP-PA] assay, etc.). False positive non-treponemal tests are seen in pregnancy so confirmatory testing with a treponemal test is necessary to diagnose syphilis.
• Adequate treatment of syphilis as soon as possible during pregnancy dramatically decreases the rate of congenital syphilis. Syphilis known to be acquired within the prior 12 months (primary, secondary, early non-primary non-secondary) should be treated with 2.4 million units of IM Benzathine penicillin G. Syphilis acquired >12 months prior (late syphilis) or of unknown duration should be treated with Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervals. If doses are further apart than 9 days or missed, the treatment schedule must restart from the beginning.
• Patients with penicillin allergies should be desensitized and treated with penicillin as it is the only known effective antimicrobial for preventing transmission to the fetus and treating fetal infection.
• Partners should (at a minimum) be presumptively treated (2.4 million units of IM Benzathine penicillin G) to prevent reinfection during pregnancy. Ideally, they should be evaluated for syphilis by a provider and staged and treated appropriately.

Congenital syphilis in the infant

• Infants with an infection can be asymptomatic.
• Infants born to someone who wasn't treated, or someone with inadequate treatment (including those treated <30 days prior to delivery) should be evaluated and treated for congenital syphilis per CDC guidelines.

All neonates born to someone who has a reactive nontreponemal and treponemal tests should be evaluated with a quantitative nontreponemal serologic test (RPR or VDRL) and be examined thoroughly for evidence of congenital syphilis (see details in CDC treatment guidelines).

^{1. Patients with penicillin allergies should be desensitized and treated with penicillin as it is the only known effective antimicrobial for preventing maternal transmission to the fetus and treating fetal infection.}

^{2. If doses are further apart than 9 days or missed, the treatment schedule must restart from the beginning.}

^{3. If more than 1 day of therapy is missed the entire course should be restarted.}

Please report congenital syphilis cases to [name] at [health department contact info].

For questions please contact the [jurisdiction] at [phone].

Resources to share

• 2021 CDC STI Treatment Guidelines: Congenital Syphilis
• NNPTC STD Clinical Consultation Network
• National STD Curriculum
• Syphilis during pregnancy: a preventable threat to maternal-fetal health
• Guidelines for Perinatal Care (7th Edition)