Introduction
Syphilis infection in pregnant women is a common and definitely serious problem that needs careful diagnosis and treatment if appropriate. Syphilis is an opportunistic infectious disease that generally infects when someone has an active primary or secondary stage of illness with one or more infectious microbes such as bacteria, viruses, or fungi (Curry et al., 2018). Congenital syphilis is a disease that affects an infant in late pregnancy or shortly after birth due to transmission of the causative organism, “Treponema pallidum,” during pregnancy from its mother, who is a carrier of the disease (Curry et al., 2018).
The infection usually does not show the disease’s signs and symptoms at transmission time. Congenital syphilis is a rare but severe congenital disability. If a pregnant woman has syphilis, there is an increased risk of having a child with cardiac problems such as heart disease and heart defects.
Effects of Congenital Syphilis on Infants
The infection impacts the baby depending on the stage of contraction during pregnancy. The progressive central nervous system infection in an unborn baby must be given the congenital name syphilis to better understand its adverse effects on their later life (Lin, Eder & Bean, 2018). The infant’s immune system will be much less developed than a typical newborn’s, which may lead to seizures, blindness, and neurological problems (Lin et al., 2018). These problems may lead to infants being re-admitted to hospitals, where they may suffer sequels.
In addition, congenital syphilis may lead to bone and joint pain, deafness, and problems with the digestive system (Lin et al., 2018). Congenital syphilis should be considered even without clinical signs in pregnant women with partners with a history of sexually transmitted disease or if they experience primary or secondary infections during pregnancy.
Since the fetus can be affected by syphilis, irrespective of maternal serological status, screening should always be done in all pregnant women (Lin et al., 2018). It will lead to early detection and can prevent damage to the fetus. To diagnose congenital syphilis, a sample is taken from the infant’s blood, which is then analyzed on an automated analyzer. Therefore, this test is easy to conduct and can be conducted without risk to the infant.
Risk Factors and Increasing Prevalence
Congenital syphilis may cause problems with pregnancy or birth. Risk Factors for Syphilis are being raped during pregnancy, having multiple sexual partners, and having intravenous drug use (Lin, Eder & Bean, 2019). Untreated syphilis infection in pregnant women can lead to congenital syphilis in unborn babies. About 70% of pregnant women with syphilis infection will give birth to twins or triplets (Lin et al., 2019).
About 30% of cases of congenital syphilis may lead to children with HIV (Lin et al., 2019). There are about 350,000 cases of congenital syphilis in the US each year. Most of these cases occur among African American women and in rural areas. Thus, screening for syphilis infection in pregnant women is necessary to prevent congenital syphilis.
The rate of congenital syphilis is steadily increasing due to the lack of screening of pregnant women for syphilis infection in the US. As a result, the US Preventive Services Task Force (USPSTF) states that a pregnant woman who tests positive for syphilis should be tested for HIV and hepatitis B.
Suppose the woman is confirmed to have HIV. In that case, she should receive antiretroviral therapy before delivery and be treated for any other sexually transmitted infection, including chlamydia and gonorrhea, as well as any infected lesions on her skin that might involve methicillin-resistant Staphylococcus aureus (MRSA). Women should also receive outpatient treatment during pregnancy if they are not treated with penicillin or erythromycin in preparation for childbirth. Thus, it is essential to identify pregnant women infected with syphilis, especially those at high risk for congenital syphilis.
Screening, Diagnosis, and Treatment
The importance of screening for syphilis infection in pregnant women is that when syphilis is detected earlier, it can be treated more easily, and the risk of having a baby affected by congenital syphilis is reduced. In addition, treating a pregnant woman with an antibiotic in her first trimester can help prevent her baby from being born with or contracting syphilis (Mangione et al., 2022). However, other harms are associated with early detection of syphilis, such as the harm of treatment with antibiotic medications without clinical evaluation. Therefore, it is essential to screen pregnant women for syphilis infection during pregnancy, but not for syphilis if the woman does not have a history of risk factors for syphilis infection.
The clinical consideration for all pregnant women includes screening intervals where the mother has no symptoms of syphilis and when a mother is at high risk for having syphilis. The Centers for Disease Control and Prevention (CDC) recommends screening pregnant women at high risk of infection with syphilis (Mangione et al., 2022). These include people who are high-risk, sexually active, including those who are engaging in risky sexual behavior, such as having multiple sex partners or having unprotected sex (Mangione et al., 2022). The CDC recommends screening these women for syphilis at the first prenatal visit. The National Institutes of Health (NIH) also recommends that pregnant women be tested for syphilis during early pregnancy, regardless of risk factors, to ensure that all mothers can have good maternal and fetal outcomes.
In addition to the point above, the other clinical consideration is a screening test where the mother has no symptoms of syphilis, where laboratory tests are the only way to detect syphilis in a pregnant woman without symptoms. It is known as serologic screening, the standard for diagnosing syphilis infection during pregnancy. A blood sample taken from a pregnant woman during her first prenatal care visit does not have enough antibodies to be detected by an enzyme immunoassay (EIA) test, the primary screening test for syphilis currently used in the United States (Mangione et al., 2022). Therefore, these tests are used to detect antibodies to Treponema pallidum under conditions where the mother has no symptoms of syphilis.
The recommended treatment for syphilis in pregnant women is parenteral benzathine penicillin G. Other approaches to prevent syphilis infection include latex condoms, which can reduce the risk of syphilis. Another approach is screening and treating sex partners of people with syphilis (i.e., contact tracing), which can help prevent new cases among others who have been exposed to syphilis (Lochner & Maraqa, 2018).
Also, healthcare providers should know how to treat and test pregnant women with syphilis and manage babies born with or who acquire congenital syphilis in their first few months of life (Lochner & Maraqa, 2018). Finally, regular follow-up testing must be available for women and infants after they are treated so that they can identify if any problems continue or develop later on, such as HIV infection, hearing loss, and developmental delay(Lochner & Maraqa, 2018). Therefore, the most crucial plan women must follow after being tested and treated for syphilis is to avoid being re-infected.
Conclusion
In conclusion, screening pregnant patients for syphilis infection is the first step that women must follow after they are infected. If the woman has no risk factors for syphilis, she should be screened for syphilis, which is a serologic screening test. During pregnancy, to ensure that congenital syphilis does not occur. Although screening a pregnant woman without symptoms of syphilis is possible, it should be done if there are no other reasons not to have been screened.
References
Curry, S. J., Krist, A. H., Owens, D. K., Barry, M. J., Caughey, A. B., Davidson, K. W.,… & US Preventive Services Task Force. (2018). Screening for syphilis infection in pregnant women: US Preventive Services Task Force reaffirmation recommendation statement. Jama, 320(9), 911-917. Web.
Lin, J. S., Eder, M. L., & Bean, S. I. (2018). Screening for syphilis infection in pregnant women: updated evidence report and systematic review for the US Preventive Services Task Force. Jama, 320(9), 918-925. Web.
Lin, J. S., Eder, M. L., & Bean, S. I. (2019). Screening for Syphilis Infection in Pregnant Women: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. Obstetrical & Gynecological Survey, 74(2), 75–76. Web.
Lochner, H. J., & Maraqa, N. F. (2018). Sexually transmitted infections in pregnant women: integrating screening and treatment into prenatal care. Pediatric Drugs, 20(6), 501-509. Web.
Mangione, C. M., Barry, M. J., Nicholson, W. K., Cabana, M., Chelmow, D., Coker, T. R.,… & US Preventive Services Task Force. (2022). Screening for syphilis infection in nonpregnant adolescents and adults: US Preventive Services Task Force reaffirmation recommendation statement. JAMA, 328(12), 1243-1249. Web.