Recently, the number of patients with syphilis has increased significantly, and fetal syphilis in pregnancy is not uncommon. The following is a short summary of the questions frequently asked by patients, combined with my clinical experience.
1. What is syphilis and syphilis in pregnancy?
Syphilis (Syphilis) is a sexually transmitted disease caused by Treponema pallidum, which can invade almost all organs of the body and produce a variety of signs and symptoms. Syphilis may also remain asymptomatic for many years and be latent. Syphilis is mainly transmitted through sexual intercourse, but can also be transmitted to the next generation through the placenta, resulting in fetal syphilis.
Syphilis found during pregnancy is called gestational syphilis, which can either be formed by the patient’s infection before pregnancy or by the pregnant woman during pregnancy.
2. What are the risks of syphilis to pregnant women?
Syphilis during pregnancy can bring many adverse effects to pregnant women. The damage of hard chancre is more obvious than during non-pregnancy because the genital organs are congested and the soft tissues are flaccid during pregnancy. With early syphilis, the skin and mucous membrane damage that occurs in pregnant women can be generalized and may recur. In addition, patients are prone to osteoarthrosis, osteochondritis, and calcium deficiency convulsions. As a result of syphilis, the consumption of nutrients in the body of pregnant women increases, leading to a decrease in physical fitness, weakened resistance, wasting, and frequent throat infections. All of these can bring pain to the pregnancy. After delivery, the uterine wall lesions caused by syphilis can increase maternal bleeding and even hemorrhage, causing anemia and affecting postpartum recovery.
3.Can syphilis be transmitted to the fetus?
Not all fetuses born to pregnant women with syphilis will suffer from congenital syphilis. Whether or not a syphilis patient gives birth to a congenital syphilis child is related to the duration of the patient’s disease and the availability of standard treatment. The probability of congenital syphilis in the fetus decreases as the duration of the disease increases. It is possible to have a healthy baby after more than 5 years of disease; beyond 10 years, the chances of fetal infection are minimal. If a mother with syphilis in pregnancy is adequately treated within the first 16 weeks of pregnancy, she can almost completely prevent the occurrence of congenital syphilis children; if she starts adequate treatment at 20-24 weeks of pregnancy, she may cure fetal syphilis but cannot prevent all congenital syphilis children from being born; if she starts treatment only in late pregnancy, a considerable number of congenital syphilis children will be born.
4.What are the risks of syphilis in pregnancy to the fetus?
The syphilis spirochete can infect the fetus from the second week of gestation and cause miscarriage. After 16-20 weeks of gestation, syphilis spirochetes can spread to all organs of the fetus through the infected placenta, causing fetal lung, liver, spleen, pancreas and skeletal lesions, resulting in fetal stillbirth, stillbirth or premature birth. Those who can deliver normally are congenital syphilis children, and their mortality and disability rates are very high.
5.How to prevent syphilis in pregnancy?
The prevention of syphilis in pregnancy is mainly through preconception screening and prenatal screening. Overt syphilis can be diagnosed by history and signs; latent syphilis mostly has no clinical symptoms, but can be confirmed by serological examination. Latent syphilis is the main cause of syphilis in pregnancy. Therefore, couples of childbearing age should undergo serological examination for syphilis before planning a pregnancy. If syphilis infection is found, pregnancy should be delayed and systematic treatment should be carried out. At the same time, their spouses should be examined and the timing of pregnancy should be decided under the guidance of the doctor.
6.How should syphilis be treated after it is found during pregnancy?
It is found that syphilis spirochetes can cross the placenta and enter the umbilical cord blood to infect the fetus in the early, middle and late stages of pregnancy, but in early pregnancy, the immune system of the fetus is not fully developed and the syphilis immune receptors in the placental trophoblast cells are not developed, so syphilis cannot be recognized and thus lacks inflammatory response to syphilis infection. Therefore, if pregnant women infected with syphilis in early pregnancy can receive timely, standardized and adequate anthelmintic treatment, the syphilis spirochete can be killed and its further vertical transmission can be interrupted; after mid-pregnancy, the fetal immune system recognizes syphilis and has already caused damage to the placental villi or fetal organs, and anthelmintic treatment at this time has no therapeutic effect on the damage that has already occurred. Therefore, when syphilis is detected in the middle or late stages of pregnancy, pregnant women should be screened for syphilis through tests such as amniocentesis, umbilical vein blood sampling, or fetal ultrasound, along with timely treatment of syphilis.
Treatment of syphilis in pregnancy: In the early stage of pregnancy is to keep the fetus from being infected, it can be treated with penicillin, injection procaine penicillin G intramuscularly 800,000 U daily for 10 days (or benzathine penicillin G, 2.4 million U, divided into two sides of the buttocks intramuscularly, once a week for 3 times). During the first 3 months of pregnancy, one course of treatment is injected; during the last 3 months of pregnancy, another course of treatment is injected. Treatment in late pregnancy is to be the infected fetus cured before delivery and also to treat the pregnant woman. Treatment is benzathine penicillin 2.4 million U intramuscularly, once a week for 3 weeks. For those who are allergic to penicillin, other antibiotics can be chosen for treatment.
7.What are the requirements for follow-up and retreatment of syphilis in pregnancy?
If the syphilis serological titer does not decrease by 2 dilutions or increase within 3 months, it should be retreated. After delivery, follow up according to general syphilis cases (generally 2-3 years of follow up, review every 3 months in the first year, and every 6 months thereafter). If serum recurrence or symptom recurrence is found, the amount of retreatment should be doubled. Those with fixed serologic response (not turning negative) after early syphilis treatment without clinical symptoms should consider cerebrospinal fluid examination to exclude asymptomatic neurosyphilis, depending on the situation. Late syphilis and late latent syphilis, such as serum fixation after treatment, need to be followed up for 3 years to determine whether to terminate observation.
8.How are babies born to pregnant women with adequately treated syphilis followed up?
If the infant is born with a positive serological reaction, the infant should be examined once a month for 8 months. If the serologic reaction turns negative and no clinical manifestations of congenital syphilis appear, observation can be stopped.
If the serologic reaction is negative at birth, the test should be repeated at 1 month, 2 months, 3 months and 6 months after birth. If the serologic reaction is still negative at 6 months and there is no clinical manifestation of congenital syphilis, congenital syphilis can be excluded.
Regardless of the positive or negative seropositivity at birth, if the seropositivity titer gradually increases or clinical manifestations of congenital syphilis appear during the follow-up period, treatment should be given immediately.
9.Can breastfeeding be done after pregnancy?
Mothers who have undergone standard treatment can breastfeed their healthy babies after the serological test for syphilis has turned negative. In mothers without standard treatment, although there is no evidence of the presence of live spirochetes in breast milk, there is a risk of infection of the fetus through a small break in the skin around the nipple, so it is recommended to avoid breastfeeding.
10. When can a woman with syphilis become pregnant?
Pregnancy is possible if the serum is negative after standard treatment. Usually two years after treatment for syphilis.
If the serum is fixed or low titers are not negative after standard treatment, it is recommended to follow two courses of syphilis treatment during pregnancy (i.e. one course in the first three months and one course in the last three months), which has been reported in the literature to protect the fetus from syphilis infection.