Syphilis during pregnancy brings profound harm, and sometimes death, to babies. Testing protocols and non-specific symptoms present a serious diagnostic challenge for clinicians – but increasing case numbers mean the need to meet it is widespread and urgent.
“An increase of syphilis in women, including those of reproductive age, has led to the re-emergence of congenital syphilis, including foetal deaths in Victoria,” says Dr Stephanie Bond, obstetrician-gynaecologist and sexual health physician at the Melbourne Sexual Health Centre, Mercy Hospital for Women and Royal Women’s Hospital.
“In Victoria, syphilis cases who were pregnant at the time of diagnosis increased from 14 in 2016 to 57 in 2019. Most were treated successfully, but since 2017 there have been 17 congenital syphilis cases, including 8 stillbirths.”
This is a concerning trend, not least because syphilis should be a preventable and curable infection in an Australian setting.
The rise in cases often reflects a lack of access to health care on the part of the patient. Equally, though, there is evidence to show that some clinicians aren’t fully across the risks and manifestations of the disease.
Testing for syphilis at several stages of pregnancy, says Dr Bond, should be seen as a health care priority.
“Recent cases of congenital syphilis, in Australia and overseas, have been seen in individuals who tested negative early in their pregnancy and acquired the infection later in pregnancy,” she explains.
“Approximately 50 per cent of women with untreated syphilis in pregnancy will have a miscarriage, stillbirth, preterm labour or a baby with severe physical or neurological disability.
“Once the spirochete that causes syphilis enter the foetal blood circulation they can infect multiple organs. The intense inflammatory response created can cause many differing clinical manifestations including hepatitis, anaemia, visual problems, and neurological damage.”
And, she adds, absence of symptoms at birth does not necessarily mean absence of disease.
“Some babies with congenital syphilis will be asymptomatic at birth and, if they do not receive treatment, will develop signs over the first months to years of life,” she says.
In order to raise clinician awareness of detecting and treating syphilis in pregnancy, Dr Bond will be leading a webinar on the subject on 22 February, 2024.
Presented by Victorian HIV and Hepatitis Integrated Training and Learning (VHHITAL), the 2-hour interactive event will assist participants to provide syphilis screening to patients, interpret syphilis serology and conduct appropriate treatment.
As well as learning how to identify those at risk, and discuss partner notification, contact tracing and appropriate onward referral.
The webinar is free, and open to general practitioners, practice nurses and managers, and allied health practitioners.
Numbers are limited, however. For more details and to register, go to this webpage.
You can also check out VHHITAL’s congential syphilis primer video here.