Prevention and treatment of mother-to-child transmission of syphilis.

PURPOSE OF REVIEW: Athough more than 90% of syphilis cases are diagnosed in developing countries, syphilis rates in industrialized countries have been increasing since the 1980s. Untreated syphilis in pregnancy is associated with high rates of adverse pregnancy outcomes, including fetal loss, premature birth, congenital syphilis, and neonatal death. We reviewed the recent literature on adverse pregnancy outcomes associated with untreated syphilis and the benefits of early and effective treatment.

RECENT FINDINGS: Up to two-thirds of pregnant women with untreated syphilis may develop unwanted complications compared with a background rate of 14% in pregnant women without syphilis. A review of interventions to screen and manage infections during pregnancy found that those focusing on syphilis demonstrated an 80% reduction in stillbirths as compared with strategies to treat, detect, or prevent other infections in pregnancy, such as malaria (22% reduction), HIV (7% reduction) or bacterial vaginosis (12% reduction). Detection and treatment of syphilis before the third trimester (28 weeks) can revert the risk of adverse outcomes to background rates.

SUMMARY: Transplacental transmission of syphilis, especially in the third trimester, is associated with high rates of adverse outcomes, but the risk can be significantly reduced with early detection and treatment in the first and second trimesters, along with careful management of the infant after birth.