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October 28, 2024
Congenital syphilis cases have surged in recent years, both nationally and in Illinois.
Since 2000, national data indicates a 459% increase in syphilis cases. Among infants, congenital syphilis has increased 255% in Illinois. Mirroring national and state-wide trends, Lake County has experienced an overall increase in syphilis cases (Provider Updates on Perinatal Syphilis). Timely detection and adequate treatment of syphilis in pregnant individuals are critical to preventing transmission to infants.
Congenital Syphilis Signs and Symptoms
Early symptoms (within the first 2 years of life):
- Rash, especially on the palms and soles
- Snuffles (syphilitic rhinitis)
- Hepatosplenomegaly (enlarged liver/spleen)
- Jaundice, anemia, or failure to thrive
Late symptoms (if untreated):
- Developmental delays
- Bone abnormalities
- Deafness and vision problems
Congenital syphilis can cause stillbirth, prematurity, miscarriage, low birth weight, and death shortly after birth.
Required and Recommended Testing Frequency
Per the test all pregnant individuals for syphilis:
- At the first prenatal visit
- During the third trimester (28-32 weeks)
- Additional testing at delivery is recommended for individuals who are at high risk (i.e. recent STI diagnosis, multiple or new sexual partners)
- When a stillbirth is experienced
- The individual lives in an area with high syphilis rates
Testing and Diagnosis
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Screening Test: Perform non-treponemal tests (e.g., RPR or VDRL).
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Confirmatory Test: If the screening test is positive, confirm with a treponemal test (e.g., FTA-ABS or TP-PA).
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Neonatal Testing: For infants born to syphilis-positive mothers, test using both non-treponemal and treponemal tests. Clinical signs may guide diagnosis.
For more information, check out the IDPH’s Syphilis Rapid Testing Algorithm and Traditional and Reverse Sequence Screening Algorithm.
Treatment
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Pregnant Patients: Treat syphilis promptly with intramuscular benzathine penicillin G. Follow for treatment based on the stage of infection.
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Neonates: If congenital syphilis is suspected, treat with aqueous crystalline penicillin G or procaine penicillin G for 10 days.
Need help with adequate treatment plans?
- Illinois Department of Public Health launched the Illinois Perinatal Syphilis Warmline in 2023, to help practitioners determine adequate syphilis treatment plans during the pregnancy and newborn period, coordinate public health record searches to obtain prior syphilis testing and treatment information, and assist with mandatory case reporting.
Illinois Perinatal Syphilis Warmline: 1-800-439-4079
(Monday – Friday, 8 p.m. – 4 p.m., messages will be returned in 1 business day)
- Congenital Syphilis Treatment Cheat Sheet
- Staging and Treatment Algorithm
- CDC Treatment Guidelines
Reporting Syphilis Cases
Syphilis is a notifiable condition and should be reported within 3 days of diagnosis.
Call to Action
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Screen All Pregnant Patients: Ensure syphilis testing at the first prenatal visit and during the third trimester.
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High-Risk Patients: Test at delivery for those at increased risk.
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Treat Immediately: Begin treatment immediately for confirmed syphilis in pregnant patients to prevent congenital transmission.
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Report Cases: Please report all cases of syphilis, including congenital syphilis, promptly using one of the following methods:
- LCHD’s STI Program via phone (847) 377-8450, fax (847) 360-2920
- IDPH’s online reporting form
- The Illinois Disease Surveillance System (IDSS).
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