Research Article| Volume 259, P207-210, April 2021

Download started.


Syphilis in pregnancy: The impact of “the Great Imitator”

Published:February 01, 2021DOI:


      Syphilis remains a common congenital infection over the globe. There has been a tremendous rise in the number of congenital syphilis cases worldwide in the last 20 years. It affects large numbers of pregnant mothers in high burden regions causing a significantly high perinatal mortality and morbidity, which can be easily prevented by early antenatal screening and treatment.
      Diagnosis of maternal syphilis in pregnancy mainly based on clinical symptoms, serological tests and direct identification of treponemes in clinical samples. However, the diagnosis can be challenging due to the relapsing-remitting nature of the disease. The early stage of the infection is usually symptomatic which is commonly followed by an asymptomatic latent phase but infectious and as a result serological tests will be positive. The risk of transplacental transmission is high during the second and third trimester.
      Obstetric complications of syphilis include spontaneous miscarriage, non-immune hydrops, stillbirth, preterm labour, low birth weight, increased neonatal mortality and congenital syphilis among neonates.
      Penicillin is the drug of choice for treatment and should be commenced immediately. Babies born to mothers with syphilis should also be treated with penicillin. Early detection and prompt intervention are the key to the prevention and successful control of congenital syphilis. The aim of this review is to highlight the impact of syphilis infection on pregnancy and discuss the current trends in diagnosis and management of maternal and congenital syphilis.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


        • Tsimis M.E.
        • Sheffield J.S.
        Update on syphilis and pregnancy.
        Birth Defects Res. 2017; 109 (PMID: 28398683): 347-352
        • Khan S.
        • Menezes G.A.
        • Dhodapkar R.
        • Harish B.N.
        Seroprevalence of syphilis in patients attending a tertiary care hospital in Southern India.
        Asian Pac J Trop Biomed. 2014; 4: 995-997
        • Saloojee H.
        • Velaphi S.
        • Goga Y.
        • Afadapa N.
        • Steen R.
        • Lincetto O.
        The prevention and management of congenital syphilis: an overview and recommendations.
        Bull World Health Organ. 2004; 82 (pp. 424–430)008094
        • Korenromp E.L.
        • Mahiané S.G.
        • Nagelkerke N.
        Syphilis prevalence trends in adult women in 132 countries – estimations using the Spectrum Sexually Transmitted Infections model.
        Sci Rep. 2018; 8: 1-10
        • Public Health England
        Addressing the increase in syphilis in England: PHE action plan.
        Public Health England, London2019 ( June_2019.pdf)
        • Public Health England
        Syphilis epidemiology in London. Sustained high numbers of cases in men who have sex with men.
        Public Health England, London2016
        • HIV-STIs
        Recent epidemiology of infectious syphilis and congenital syphilis.
        Infect Rep Health Protect Rep. 2013; 7 (publication withdrawn February 2020)
        • Singh A.E.
        • Romanowski B.
        Syphilis: review with emphasis on clinical, epidemiologic, and some biologic features.
        Clin Microbiol Rev. 1999; 12: 187-209
        • Norris S.J.
        • L S.A.
        Treponema and other host-associated spirochetes.
        in: Manual of clinical microbiology. vol. 6. ASM Press, Washington, D.C1995: 636-651
        • Ratnam S.
        The laboratory diagnosis of syphilis.
        Can J Infect Dis Med Microbiol. 2005; 16: 45-51
        • Larsen S.A.
        Clin Lab Med. 1989; 9: 545-557
        • Lafond R.E.
        • Lukehart S.A.
        Biological basis for syphilis.
        Clin Microbiol Rev. 2006; 19: 29-49
        • Noordhoek G.T.
        • Hermans P.W.
        • Paul A.N.
        • Schouls L.M.
        • van der Sluis J.J.
        • van Embden J.D.
        Treponema pallidum subspecies pallidum (Nichols) and Treponema pallidum subspecies pertenue (CDC 2575) differ in at least one nucleotide: comparison of two homologous antigens.
        Microb Pathog. 1989; 6: 29-42
        • Centurion-Lara A.
        • Castro C.
        • Castillo R.
        • Shaffer J.M.
        • Van Voorhis W.C.
        • Lukehart S.A.
        The flanking region sequences of the 15-kDa lipoprotein gene differentiate pathogenic treponemes.
        J Infect Dis. 1998; 177: 1036-1040
        • Moore Jr., M.B.
        • Price E.V.
        • Knox J.M.
        • Elgin L.W.
        Epidemiologic treatment of contacts to infectious syphilis.
        Public Health Rep. 1963; 78: 966-970
        • Schroeter A.L.
        • Turner R.H.
        • Lucas J.B.
        • Brown W.J.
        Therapy for incubating syphilis. Effectiveness of gonorrhea treatment.
        JAMA. 1971; 218: 711-713
        • Kaur G.
        • Kaur P.
        Syphilis testing in blood donors: an update.
        Blood Transfus. 2015; 13: 197-204
        • Zhou H.
        • Chen X.S.
        • Hong F.C.
        Risk factors for syphilis infection among pregnant women: results of a case-control study in Shenzhen, China.
        Sex Transm Infect. 2007; 83: 476-480
        • Kingston M.
        • French P.
        • Higgins S.
        • McQuillan O.
        • Sukthankar A.
        • Stott C.
        • et al.
        UK national guidelines on the management of syphilis 2015.
        Int J STD AIDS. 2016; 27 (Epub 2015 Dec 31. PMID: 26721608): 421-446
        • De Santis M.
        • De Luca C.
        • Mappa I.
        Syphilis Infection during pregnancy: fetal risks and clinical 13 management.
        Infect Dis Obstet Gynecol. 2012; 2012430585
        • Gust D.A.
        • Levine W.C.
        • St Louis M.E.
        • Braxton J.
        • Berman S.M.
        Mortality associated with congenital syphilis in the United States, 1992–1998.
        Pediatrics. 2002; 109: E79-79
        • Liu J.B.
        • Hong F.C.
        • Pan P.
        • Zhou H.
        • Yang F.
        A risk model for congenital syphilis in infants born to mothers with syphilis treated in gestation: a prospective cohort study.
        Sex Transm Infect. 2010; 86: 292-296
        • De Santis M.
        • De Luca C.
        • Mappa I.
        Syphilis Infection during pregnancy: fetal risks and clinical management.
        Infect Dis Obstet Gynecol. 2012; 2012430585
        • Ingall D.
        • Sanchez P.J.
        • Bakes C.J.
        Syphilis: infectious diseases of the fetus and newborn infant.
      1. Centers for Disease Control and Prevention; Public Health Image Library (PHIL). Atlanta: CDC; 2020.

      2. Centers for Disease Control and Prevention; Public Health Image Library (PHIL). Atlanta: CDC; 2020.

        • Simms I.
        • Tookey P.A.
        • Goh B.T.
        • Lyall H.
        • Evans B.
        • Townsend C.L.
        • et al.
        The incidence of congenital syphilis in the United Kingdom: February 2010 to January.
        Br J Obstetr Gynaecol (BJOG). 2015;
        • Division of STD prevention
        • National Center for HIV/AIDS
        • Viral Hepatitis, STD and TB prevention
        • Centers for Disease Control and Prevention
        Sexually transmitted diseases treatment guidelines.