Syphilis: A neglected problem

The ongoing Zika virus epidemic has been and is still today an important topic in the Americas. There is, however, another serious health issue for pregnant women and their unborn babies which is far less frequently addressed: syphilis.

According to current data, there were 33,000 infected pregnant women in Brazil in 2015, twenty times as many as ten years ago, and the number is still growing.

Syphilis is caused by an infection with the bacterium Treponema pallidum. It is usually passed on by unprotected sexual contact with an infected person. Therefore, it belongs to the STIs, sexually transmitted diseases. In around half of the infected people, syphilis takes a symptomatic course which may become chronic in the final phase and also affect the nervous system.

Infections with T. pallidum may lead to severe complications particularly during pregnancy, since the pathogen can be transplacentally passed on from the mother to the foetus. The pathogen is one of the so-called TORCH parameters, which a woman should be tested for within the pre-natal care. Thus, with the number of pregnant infected women in Brazil, also the number of infants (< 1 year) who got infected during pregnancy has increased from 5,800 (2005) to around 19,000 (2015). This so-called congenital syphilis may result in severe malformations and developmental disorders of the embryo. In up to 40% of cases, untreated congenital syphilis may lead to abortion, miscarriages, silent or premature births or death of the baby shortly after birth according to the Robert-Koch Institute. In Brazil, over 1,300 abortions and silent births due to syphilis were registered in the last year.

For comparison: WHO/PAHO reports that, up to December, around 2,200 cases of cranial malformations in newborns were reported in Brazil in 2016 due to congenital Zika virus infections (which corresponds more or less to 1/8 of cases of congenital syphilis), 6 newborns died as a result of the condition.

Increase in cases of syphilis in other countries

However, not only Brazil, but also the US and Germany have registered an increase in cases of syphilis over the past years. According to the CDC, there were 36% more cases of congenital syphilis in the US in 2015 than in 2011. Within the same period of time, the number of infections in women increased by 55% (2011-2015).

Likewise, the Robert-Koch Institute has registered an increase in reported cases of syphilis in Germany by 19% in men and by 16% in women, between 2014 and 2015. In both countries, the absolute numbers of infections in women are, however, clearly below the number of infections in men. Particularly in the group of homosexual men, there has been an increase of cases over the past years.

The growing number of syphilis cases suggests that the topic is not addressed as required. There seems to be a need for improvement in the measures for prevention, diagnosis and therapy of syphilis. If diagnosed at an early stage, syphilis can be successfully treated with antibiotics.

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