Syphilis

Introduction to Syphilis and Transmission in Pregnancy

Syphilis is a chronic systemic sexually transmitted infection caused by the spirochete bacterium Treponema pallidum. In pregnant women attending antenatal clinics in Nigeria, this infection remains a major public health concern because it crosses the placenta with devastating ease. Transmission can occur at any gestational age, though the risk of fetal damage increases significantly as the pregnancy progresses into the second and third trimesters. The organism enters the body through microscopic abrasions in the mucosa or skin during sexual contact, rapidly invading the bloodstream to disseminate throughout the body tissues, including the uteroplacental unit.

Stages of Syphilis: Primary, Secondary, Latent, and Tertiary

• Primary Syphilis: Characterized by a painless ulcer called a chancre at the site of inoculation, usually appearing about three weeks after exposure and healing spontaneously.
• Secondary Syphilis: Manifests weeks to months later with a generalized non-itchy rash, particularly on the palms and soles, accompanied by generalized lymphadenopathy and mucous patches.
• Latent Syphilis: A period of hidden infection where clinical signs disappear entirely, though serological tests remain strongly positive. It is subdivided into early and late latent periods.
• Tertiary Syphilis: The late stage causing severe damage to the cardiovascular system, central nervous system, and gummatous lesions in skin and bones if left untreated for years.

Implications for the Fetus and Congenital Syphilis

When a pregnant woman has untreated syphilis, the consequences for the fetus are severe. The infection can lead to spontaneous abortion, stillbirth, non-immune hydrops fetalis, premature delivery, and low birth weight. Surviving infants often manifest congenital syphilis, which may present early with hepatosplenomegaly, snuffles, copper-colored skin lesions, and osteochondritis. Late manifestations appearing after two years of age include Hutchinson's teeth, Mulberry molars, saber shins, and eighth nerve deafness. Routine screening remains our best defense against these catastrophic outcomes.

Diagnostic Screening and Antenatal Testing

Midwives play a critical role in identifying syphilis by offering routine screening at the first booking visit. Diagnosis relies on a combination of nontreponemal and treponemal tests.

Rapid diagnostic tests (RDTs) are increasingly used in resource-limited primary health centers across Nigeria to provide same-day results and immediate treatment initiation.

Clinical Management and Treatment Protocols

The gold standard treatment for syphilis across all stages in pregnancy is Benzathine penicillin G. The dosage and duration depend strictly on the staging of the disease. For early syphilis, a single intramuscular injection is usually adequate. For late latent syphilis, weekly injections for three consecutive weeks are required. Pregnant women with penicillin allergies present a therapeutic challenge because alternative drugs like tetracycline or doxycycline are contraindicated during pregnancy due to fetal bone and teeth damage. Desensitization to penicillin in a hospital setting is the recommended clinical pathway for allergic patients.

Prevention, Partner Notification, and Follow-up Care

Treating the pregnant woman alone is insufficient if her sexual partner remains infected, as reinfection will occur rapidly. Partner notification and simultaneous treatment of all sexual contacts diagnosed within the appropriate timeframe are vital components of comprehensive care. Midwives must counsel couples sensitively to encourage partner attendance at the clinic. Furthermore, follow-up VDRL or RPR titers must be checked at specific intervals during pregnancy to confirm a successful response to therapy and rule out reinfection before delivery.