Syphilis and pregnancy

Another infection that is dangerous in terms of intrauterine infection of the fetus is syphilis.

Like tuberculosis, syphilis was once considered a social disease associated with the insufficient cultural level of the population. It is impossible to say with certainty that this is not so, since successes in the fight against it were obvious at a certain stage. A special role was played by the fact that patients with syphilis were sought almost like criminals (with the police) and were forcibly treated, thereby interrupting the further chain of infection. Today, approaches to identifying and treating this disease have changed somewhat. And if 15-20 years ago demonstrating a patient with syphilis to medical students was a rare success for a teacher, now this infection has again become quite widespread in society.

Congenital syphilis as a cause of stillbirths occurs in 0.5-0.8% of cases. Fetal infection occurs regardless of whether the woman was ill before pregnancy or was infected during or after conception. Moreover, the fetus is affected the sooner, the shorter the period that has passed since the moment of infection. Thus, if a woman has had several pregnancies after infection, then with each subsequent one the risk of intrauterine infection decreases and the pregnancy may even end with the birth of a healthy child. However, it should be noted that the birth of a healthy child is still observed mainly in treated women.

Usually, intrauterine infection of the fetus with pale spirochete (the causative agent of syphilis) occurs between 6 and 8 months of pregnancy (very rarely earlier). Moreover, the spirochetes immediately get to the fetus, and only later the placenta is damaged. Having entered the fetus's body, the spirochetes multiply and cause specific changes in its tissues. Most often, the liver, lungs, and bone tissue are affected.

In addition to the above changes, newborns with congenital syphilis also have other symptoms: rhinitis (syphilitic runny nose), pemphigus (blisters on the skin), and, unlike pemphigus caused by pyogenic microorganisms (staphylococci), with syphilitic pemphigus, blisters can appear on the palms and feet of the newborn. Symptoms of congenital syphilis may not appear immediately, but after some time (up to 10 weeks).

The placenta is affected after the fetus is infected. The spirochetes enter the placenta through the umbilical vessels and cause damage to the vessel walls. These changes are widespread and seriously disrupt all functions of the placenta. If this happens, the fetus dies in utero and the pregnancy ends in either miscarriage or premature birth.

According to statistics, spontaneous abortions in women with syphilis occur in 10-15% of cases, stillbirths - in 5-50%, and the birth of sick children - in 20-30% of cases. Prevention of congenital syphilis consists in the fact that all pregnant women infected with syphilis undergo serological testing twice: once in the first half of pregnancy and once in the second. If a woman shows signs of active syphilis, she is subject to treatment.

Specific antisyphilitic treatment should be started from the very beginning of pregnancy to prevent the possibility of pale spirochetes passing through the placenta in a timely manner. During subsequent pregnancies, treatment of syphilis is necessarily repeated. As with tuberculosis, treatment of syphilis is carried out taking into account the possibility of drug-induced fetopathy. Treatment is also carried out for newborns, even in cases where the mother has received a full course of antisyphilitic therapy.