Syphilis in pregnancy

What is syphilis?

Syphilis is a sexually transmitted infection (also called STI, sexually transmitted disease or STD). An STI is an infection you can get from having unprotected sex or intimate physical contact with someone who is infected. You can get an STI from unprotected vaginal, anal or oral sex. You also can get syphilis by having direct contact with (touching or kissing) an infected person’s syphilis sore. Sores usually are found on the external genitals (also called sex organs) or in the vagina, anus or rectum. They also can be on a person’s lips and in the mouth.

If you have syphilis and don’t get treated right away, you can pass the infection to your baby. Up to 2 in 5 babies (40 percent) born to women with untreated syphilis die from the infection. Most of the time, syphilis is passed from mom to baby duirng pregnancy, but it can happen during vaginal birth if a baby has direct contact with a syphilis sore. Vaginal birth is when contractions in your uterus (womb) help push your baby out through the vagina. When your baby is born with syphilis, it’s called congenital syphilis. 

At your first prenatal care visit, your health care provider does a blood test to check for STIs like syphilis. Your provider also asks about your sexual history to see if you may be at risk for having syphilis. A sexual history is a set of questions your provider asks about your sex life. For example, your provider asks about your sex partners, what kinds of sex you have, if you use birth control, if you’ve had an STI in the past and how you protect yourself from STIs. If your provider thinks you may have syphilis or another STI based on your sexual history, she may test your blood again in your third trimester and after you give birth.

Can syphilis during pregnancy cause problems for your baby?

Yes. Having syphilis can cause problems during pregnancy, including:

• Miscarriage. Miscarriage is when a baby dies in the womb before 20 weeks of pregnancy.
• Premature birth. This is birth that happens too soon, before 37 weeks of pregnancy.
• Fetal growth restriction (also called growth-restricted, small for gestational age or small for date) and low birthweight. Fetal growth restriction is when a baby doesn’t gain the weight she should before birth. Low birthweight is when a baby is born weighing less than 5 pounds, 8 ounces.
• Problems with the placenta and the umbilical cord. The placenta grows in your uterus (womb) and supplies your baby with food and oxygen through the umbilical cord. Congenital syphilis may cause the placenta to grow large and the umbilical cord to be swollen, which can cause problems with how they work to support your baby in the womb.
• Stillbirth. This is when a baby dies in the womb after 20 weeks of pregnancy.

Having syphilis during pregnancy can cause problems for your baby after birth, too, including neonatal death and serious lifelong health conditions for your baby. Neonatal death is when a baby dies in the first 28 days of life.

Stillbirth and neonatal death are more likely to happen to your baby if you have syphilis and don’t get treated.  

What are the signs and symptoms of syphilis and how is syphilis treated?

Signs and symptoms of syphilis depend on how long you’ve been infected and when you get treatment. Even if your signs and symptoms go away without treatment, the infection can get worse. If you think you have syphilis, tell your provider. If you’re pregnant, have syphilis and get treated for syphilis before 26 weeks of pregnancy, your baby is probably safe from the infection.

Signs and symptoms of syphilis happen over time in stages. The stage you’re in depends on whether or not you get treatment. Treatment usually is with an antibiotic called penicillin. Antibiotics are medicines that kill infections caused by bacteria. Treatment can prevent you from moving to the next stage, so it’s important to get treated as soon as you know you’re infected. Stages of syphilis include:

Primary syphilis. The first sign of syphilis is a small, hard, painless sore called a chancre that usually develops in the genital or vaginal area. You may have one or a few sores. They last for about 6 weeks, even if you get treatment.

Secondary syphilis. In the second stage, you have sores and a rash on the palms of your hands and on the bottoms of your feet. You also may have:

• Fever
• Swollen lymph nodes. Lymph nodes are glands throughout the body that help fight infection. You usually can’t feel lymph nodes unless they’re swollen.
• Sore throat
• Hair loss
• Headaches
• Weight loss
• Muscle aches and fatigue. Fatigue is being really tired and having little energy.

Latent syphilis. In this stage, your signs and symptoms go away, but you’re still infected. The infection can stay in your body for years without having any signs or symptoms.

Late syphilis. If you don’t get treatment for syphilis, you can have signs and symptoms later in life, including:

• Vision problems, like blindness
• Damage to internal organs, including the heart
• Neurological problems. These affect the brain, spinal cord and nerves throughout the body. You may have problems with coordination and may have numbness or paralysis. Paralysis is when you can’t feel or move one or more parts of your body. You also may develop dementia. This is when you have problems thinking, remembering, communicating and doing daily activities.  

If you have primary or secondary syphilis, one shot of penicillin usually can cure the infection. If you have latent or late syphilis, you may need more than one shot.

How can you protect yourself from syphilis?

Here’s what you can do:

• Don’t have sex. This is the best way to protect yourself from STIs, including syphilis.
• If you do have sex, have safe sex. Have sex with only one person who doesn’t have other sex partners. If you’re not sure if your partner has an STI, use a barrier method of birth control. Barrier methods include male and female condoms and dental dams. A dental dam is a square piece of rubber that can help protect you from STIs during oral sex.
• Go to all your prenatal care checkups, even if you’re feeling fine. Many cases of syphilis happen in women who don’t get regular prenatal care. At your prenatal care checkups, your provider asks you questions to see if you may be at risk for syphilis and other infections that can affect your pregnancy. If you’re at risk for syphilis, your provider gives you a blood test to see if you have the infection.
• Get tested and treated. If you think you may have syphilis, tell your provider right away. He can test you for syphilis and begin treatment if you’re infected. The sooner you’re treated, the less likely you and your baby are to have complications from your infection.
• Ask your partner to get tested and treated for syphilis. If you get treated for syphilis, you’re no longer infected. But if your partner is infected, you can get infected again. This is called reinfection. Ask your partner to get tested and treated to protect you from infection and reinfection.

More information

• Protect your baby from syphilis (infographic)
• Centers for Disease Control (CDC)
• STDs during Pregnancy - CDC Fact Sheet

Last Reviewed: March, 2017