Recently, health officials have reported that the incidence of congenital syphilis in the US state of Mississippi has risen by more than 900 percent over five years. This constitutes a major public health crisis, according to health experts, but you probably don’t need a health expert to let you know this. Syphilis is a sexually transmitted disease and one of the notorious TORCH infections. The acronym TORCH stands for Toxoplasmosis, Others, Rubella, Cytomegalovirus (CMV), and Herpes simplex virus (HSV). Syphilis is in the “Others” category, which also includes listeriosis, varicella-zoster, and parvovirus B19.
Syphilis is caused by infection with a bacterial species called Treponema pallidum, which belongs to a category of bacteria called Spirochaetes. These bacteria have a characteristic spiral or corkscrew shape and are surrounded by a double-membrane. Syphilis is a sexually transmitted disease (STD) that manifests in stages. The first stage, which is called primary syphilis and begins approximately three weeks after one gets infected through sexual contact with an infected person, consists of a sore called a chancre. The chancre develops on the skin at the site where the T. pallidum entered the body. The chancre eventually heals, but if the primary syphilis has not been treated with antibiotic therapy, the disease returns 2-8 weeks after it heals, in a new stage, called secondary syphilis. This results from the T. pallidum spreading through the blood. Symptoms and signs manifest throughout the body, particularly in the nervous system, so the condition is also called neurosyphilis.
Secondary syphilis can resolve into a period called a latent period, that is mostly asymptomatic, but punctuated by relapses. As the latent period progresses into what often is called late latent syphilis, it becomes increasingly easy for a woman who gets pregnant at this time to pass the infection to the baby. Meanwhile, the disease progresses to a still more advanced stage, called tertiary syphilis that typically strikes many years after the initial infection. Tertiary syphilis may include more manifestations of neurosyphilis, including conditions like meningitis (inflammation of the meninges, the connective tissue layers covering the brain) and issues with the blood vessels of the meninges. Tertiary syphilis also can include cardiovascular problems, involving the aortic valve (the valve between the left ventricle and the aorta, the large artery carrying blood from the left ventricle), aortic root aneurysm (ballooning of the wall of the aorta where it attaches to the left ventricle), and stenosis (narrowing) of the openings into the coronary arteries. There also can be aortitis (inflammation of the aorta), which possibly can lead to aortic dissection, meaning that a separation develops between layers of the wall of the aorta. Blood enters the resulting space, called a false lumen, which can lead the aorta to rupture all the way through.
When syphilis advances to the point of late latency period, T. pallidum can spread through the placenta and infect the fetus, leading to congenital syphilis, or even to stillbirth. Newborns who surviving congenital syphilis tend to be very small and suffer from a rash, defects of the teeth and bones, and problems with the nervous system, vision, and hearing. . Among pregnant women with syphilis, there is an 80 percent chance of passing the organism to the baby.
While data from the Centers for Disease Control and Prevention (CDC) show an incidence of congenital syphilis that doubled from 941 in 2017 to more than 2,677 in 2021, things are much worse in Mississippi, in particular. In 2020, 70 percent of Mississippi’s cases of congenital syphilis occurred in African Americans, who comprised only about 42 percent of live births that year. On top of this, studies show that the overall incidence of congenital syphilis has increased nine-fold over five years.
Diagnosis of syphilis is made in the laboratory, with a couple of different blood tests. Pregnancy can make these tests falsely positive, meaning that they can come out positive when you don’t have a syphilis infection. However, diagnosis is confirmed either by observing the T. pallidum organism on what’s called darkfield microscopy, or after performing what’s called polymerase chain reaction (PCR) to amplify DNA whose sequence then can be read to identify the organism. When neurosyphilis is suspected, doctors may also draw samples of fluid from around your spinal cord in a procedure called a lumbar puncture. When cardiovascular syphilis is suspected, the chest will be imaged, and doctors will perform various tests on the heart itself.
Treatment for syphilis is with penicillin G. This medication must be injected, and it is safe during pregnancy. An alternative medication for people who are allergic to penicillin is doxycycline, but this medication is supposed to be avoided during pregnancy. In cases of pregnant women with syphilis who are allergic to penicillin, doctors will try desensitization treatment that can make it possible for the patient to receive penicillin, with monitoring. Additional antibiotic drugs that can used for syphilis include macrolides and cephalosporins.
