Congenital syphilis (early and late): is it curable? How to treat?

In Brazil, there were 214 thousand registered cases of congenital syphilis between 1998 and 2019, according to the Ministry of Health. Therefore, prenatal care is essential, as it helps in the diagnosis, monitoring and prevention of this and other diseases.

Do you want to know more about this disease? Then check out our text:

What is congenital syphilis?

Congenital syphilis occurs when the child is infected by vertical transmission by the bacteria Treponema Pallidum, which causes syphilis. That is, still in the mother’s womb or during childbirth, through the transplacental route or through contact with contaminated blood.

This disease can also be transmitted to the baby even when breastfeeding (not because of milk but because of wounds on the breast).

The chances of transmission are greater if the woman who has syphilis does not treat the disease correctly.

In this case, congenital syphilis can cause spontaneous abortions, stillbirth, fetal death or even compromise the baby’s development after birth. However, the disease is not always easily diagnosed. This is because 50% of them are asymptomatic at birth.

What is early congenital syphilis?

Early congenital syphilis occurs when the baby comes into contact with the disease during pregnancy or childbirth, but the symptoms appear until the 2nd year of life.

If the contagion happens while it is still inside the belly, there are possibilities of premature birth or birth with low weight. But there are not always clear signs of congenital infection.

If the child is born apparently healthy, then, after delivery, she will be subjected to skin and mucosa tests before being discharged from the maternity hospital.

However, in cases not diagnosed early, it is possible that the symptoms appear until the 2nd month (early congenital syphilis) or appear only later (late congenital syphilis).

What is late congenital syphilis?

Late congenital syphilis occurs when the disease manifests itself from the child’s 2nd year of life. It is characterized by massive lesions and can even compromise the proper functioning of some fundamental organs (brain, for example), in addition to causing diseases such as neurosyphilis and multiple sclerosis.

Other features are changes in the shape of the nose (in “saddle”), tibia (in “Saber blade”), mandible (in ” bramble ” or short) and anomalies in the mouth (“Hutchinson” teeth or elevated palatal arch) ).

Late congenital syphilis can also cause deafness and learning difficulties.

What does latent syphilis mean?

Latent syphilis is characterized by being asymptomatic, that is, it does not present any symptoms. This makes the diagnosis even more difficult to make, since when the disease is suspected, it may be that it is already in an advanced state. It can be recent or late.

What is the ICD of congenital syphilis?

The International Classification of Diseases (ICD) for congenital syphilis is A-50 .

The ICD of a disease is determined by the World Health Organization (WHO), which aims to standardize medical diagnoses.

Hey, what do you mean?

Because of the great variation of languages ​​that exist in the world, sometimes the diagnoses of patients who travel internationally (for treatments, for example) is quite confusing and makes it difficult for the medical team to act in emergencies.

For this reason, WHO has created a catalog of numbers to facilitate this identification around the world.

In the case of congenital syphilis, the subcategories follow this order:

  • A-50.0: Symptomatic early congenital syphilis;
  • A-50.1: Latent early congenital syphilis;
  • A-50.2: Unspecified early congenital syphilis;
  • A-50.4: Late congenital neurosyphilis;
  • A-50.5: Other late and symptomatic forms of congenital syphilis;
  • A-50.6: Latent late congenital syphilis;
  • A-50.7: Unspecified late congenital syphilis;
  • A-50.9: Congenital syphilis, unspecified.

Causes: how does the bacteria affect the body?

The cause of syphilis is the bacterium Treponema pallidum, which was discovered in 1905.

The microorganism is not very resistant when it is outside the organism. Water, soap and disinfectant are powerful in combating this bacterium, which on wet surfaces survives for about 10 hours.

The main form of transmission of the bacteria is through sex without the use of condoms.

Unfortunately, many people regard sex as just the act of penetration and forget that oral practice and collective masturbation can also transmit the disease.

Therefore, the use of condoms for disease prevention is recommended in all types of sexual acts

In the case of congenital syphilis, the main cause of the disease is the contamination that is present in the mother’s body and ends up being passed on to the baby.

Vertical transmission: how is congenital syphilis transmitted?

The main form of transmission of congenital syphilis is through contact between the mother’s blood and the baby’s. This can happen during pregnancy (through the placenta), at the time of delivery (through the umbilical cord or vaginal canal) or during breastfeeding (through the nipple with wounds).

In some cases, the child may manifest the first symptoms only after the 2nd year of life.

What are the signs and symptoms of congenital syphilis?

In fact, congenital syphilis is a disease that can be asymptomatic (not showing any symptoms) or be very mild and not very specific.

When signs are present, it is common to find red spots on the palms and soles of the feet, which mainly affect newborn babies.

Symptoms are also manifested according to the type of the disease.

If congenital syphilis is early , the signs are:

  • Presence of plaques on the skin or mucosa;
  • Fissures in regions close to the body orifices;
  • Infections in the anus or genitals;
  • Injuries to the central nervous system;
  • Complications in the respiratory system (which can lead to diseases like Pneumonia);
  • Enlarged liver (hepatomegaly) or spleen (splenomegaly);
  • Anemia.

If the disease is late , it is possible that there are symptoms such as:

  • Gummy lesions (similar to blisters);
  • Delimited sclerosis of organs;
  • Bone deformity (such as the tibia, the cranial forehead and the teeth).

If the child has these symptoms, the ideal is to seek pediatric assistance as soon as possible.

How is the diagnosis made?

The diagnosis of congenital syphilis depends on factors such as: pregnancy time or baby’s life span.

Generally, suspicion is raised if the mother reveals that she has the disease or when the child has symptoms.

After these speculations, the obstetrician or pediatrician requests laboratory tests that vary according to the baby’s life stage.

During pregnancy

During pregnancy, most women have no symptoms. Therefore, pregnant women should do blood tests (VDRL) to identify the presence of the bacteria.

This examination should be done in the first and third trimester of pregnancy. It is performed 2 times to ensure that the woman has not come into contact with the bacteria during pregnancy.

If the VDRL is positive, regardless of the month the pregnancy is in, treatment should be started immediately.

The pregnant woman’s sexual partner must also be treated to prevent her from becoming infected again.

After childbirth

After delivery, if there are still doubts about the child’s serology (whether or not he has the disease), there are two options.

If the child is healthy, he or she may be subjected to various tests (such as blood tests and X-rays of the bones).

If the baby has other complications (cardiac or respiratory, for example), the ideal is to collect the placenta and examine it to find out if there has been contact or not.

In these cases, medicine does not use the umbilical cord as it is less sensitive and is more likely to produce false results.

After a few months of life

The Long Bones X-ray exam is one of the most common exams performed at this stage. This is because it helps to estimate the size of the baby’s bones and whether they have suffered any impact due to the presence of the bacteria.

The treponemic serology test (FTA-Abs) is also performed. This test is a simple blood test but shows reliable results until the baby is 18 months old.

After the 2nd year of life

When the patient is over 2 years old, a blood test, known as Non-Treponemic Serology (VDRL), which is the same as for adults, is allowed.

In these cases, the diagnosis is quite complex, mainly because the child may have acquired the disease other than by the mother. This is common in cases where the baby has experienced sexual abuse, for example.

Is there a cure?

Yes, fortunately, congenital syphilis has a cure that is achieved through drug treatment.

In some cases, it may be necessary for the baby to have a pediatric follow-up for up to 18 months, just to ensure that there are no sequelae.

Even with total healing, it is still important to have routine consultations.

What is the treatment of congenital syphilis?

When a woman with syphilis becomes pregnant, it is important that she notify the doctor about this condition. There is no reason to be afraid or ashamed. In fact, this information can help save your baby’s life and ensure a safer and healthier pregnancy.

From the conversation with the obstetrician who accompanies the pregnancy, the woman and the baby can be recommended to undergo drug treatment.

What are the remedies?

To make it easier, we divided this topic between treatments based on medicines indicated for the pregnant woman and the baby, who will receive the drugs only after birth.

Come on?

Treatment for pregnant women

The pregnant woman should receive frequent doses of drugs that have Benzylpenicillin Benzatin (also called Penicillin G) as an active ingredient.

Among the remedies for pregnant women are:

  • Benzetacil (reference medicine);
  • Bepeben (similar medicine);
  • FURP Benzilpenicilina Benzatina (medicamento similar).

All of these drugs are injections that must be administered in a hospital environment, by health professionals.

These remedies act directly by preventing the reproduction of the bacteria that causes Syphilis.

The effect on the chemical in the body begins in a few hours after application and can last for up to 3 weeks.

The dosage should be recommended by a medical professional, as it varies according to the degree of the disease.

Syphilis is considered primary when the woman was diagnosed less than 1 year ago; secondary when the diagnosis was more than 1 year ago, but there was no evolution and tertiary when the disease evolved, regardless of the time it was discovered.

Thus, the table below can help to understand what is the amount of Benzylpenicillin Benzatin that is usually indicated for each case:

Degree:  Dose: Time:
Primary syphilis 2 400.000 UI Single dose
Secondary syphilis 4 800.000 UI Once a week
Tertiary syphilis 7 200.000 UI Once a week

The use of antibiotics may also be recommended in some cases. In these situations, the obstetrician is the best person to indicate what can or cannot be taken.

Treatment for the child

The baby, after birth, will be evaluated by pediatricians to decide whether or not there is a need for medication. The medications indicated vary according to the child’s life span.

Newborns up to 28 days (neonatal period) are treated with injections of benzathine penicillin G (the same as those applied to pregnant women).

They can still receive Ceftriaxone- based remedies such as:

  • Rocefin IM (reference medicine);
  • Ceftriaxone Disodium ABL Brasil (generic medicine);
  • Ceftriaxone Disodium EMS (generic medicine);
  • Ceftriaxone Dissodic Hemieptahydrate Blau (generic medicine);
  • Ceftriaxone Disodium Teuto (generic medicine);
  • Ceftriaxone Sodium Aurobindo Pharma (generic drug);
  • Ceftriaxone Sodium Eurofarma (generic medicine);
  • Celltriaxon (similar drug);
  • Trioxin (similar medicine);
  • Amplospec (similar interchangeable medicine);
  • Ceftrione (similar interchangeable medicine);
  • Ceftriax IM (similar interchangeable medicine);
  • Ceftriax IV (similar interchangeable medicine);
  • Keftron (similar interchangeable medicine);
  • Triaxin (similar interchangeable medicine);
  • Triaxon (similar interchangeable medicine);
  • Triaxton (similar interchangeable medicine);
  • Rocefin IV (new medicine).

Babies older than 28 days of life (post-neonatal period) receive doses of the same drugs, but more often. In severe situations, the medicine can be injected every 4 hours. 

Living together: how to care for a child with congenital syphilis?

If congenital syphilis is diagnosed during pregnancy, the first thing to do is to stay calm and follow medical recommendations.

If the treatment is followed correctly, the child is likely to be cured. The faster the diagnosis, the lower the risk of permanent damage.

Among these consequences that congenital syphilis can bring are changes in bones, organ involvement and problems in cognitive development.

For this reason, children often need to be accompanied by pediatric professionals, physiotherapists and psychologists to try to alleviate or even reverse these consequences of the disease.

How to prevent?

Did you know that congenital syphilis can be eradicated, if each one does his / her part?

That’s right. Know how:

Pre-conception treatment

If a woman with syphilis wishes to become pregnant, she should discuss this with the accompanying gynecologist.

This allows preventive treatment to be carried out, thus preventing the baby from coming into contact with the bacteria.

Condom use

The following sentence is already well known, but that does not make it any less important: using a condom is the best way to avoid contagion of infections or sexually transmitted diseases (STDs).

Regardless of the type of sex (oral, vaginal, anal), it is indispensable.

But what does this have to do with syphilis during pregnancy?

Well, when fewer people have the disease, the lower the contamination rates, also decreasing congenital syphilis.

Diagnosis

No one can prevent what he does not know. That is why the importance of diagnosing syphilis, whether you are a woman or a man.

In cases of suspected contact with the bacteria, seek medical advice before you even have the next sexual intercourse.

If the diagnosis is positive, it is necessary to start treatment. Previous sexual partners must be advised so that they can also seek medical help.

Breast-feeding

One of the moments that can make mothers with syphilis the most concerned is breastfeeding. After all, should I breastfeed the baby or not?

Well, that will only depend on you.

Fortunately, the bacteria is not passed into breast milk, that is, it is perfectly healthy for the baby.

However, the baby may end up contracting the disease during breastfeeding if the woman’s breasts have been injured or bruised.

In these cases, breastfeeding should be suspended until the wounds heal or for 24 hours after the last dose of Penicillin.

The practice of removing breast milk and offering it to the baby with a spoon is also not recommended, since, at the time of extraction, the liquid may end up in contact with contaminated wounds.


Congenital syphilis is a disease that can be treated and even prevented. The best person to indicate how to act in all cases is a medical professional. The Minute Healthy team brings other health posts . Check out our texts !!!

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