Syphilis in Pregnancy and Congenital Syphilis: Why Can We not yet Face This Problem? - Revista Brasileira de Ginecologia e Obstetrícia
Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(9):425-427
The increased occurrence of syphilis during pregnancy, and its severe repercussions to the fetal environment, has been a cause for concern among health care professionals. It is hard to comprehend why congenital syphilis has not yet been controlled, since its agent, the spirochaete Treponema pallidum, is well known and is highly susceptible to penicillin, a low cost and easily available drug. When we compare the control of mother-to-child transmission (MTCT) of HIV with that of syphilis, it is even harder to understand why we have such success with the first one and disastrous results with the second!
When we evaluate the epidemiology of syphilis in pregnancy and in the general adult population, we notice that there were great expectations to eradicate this disease after WWII, when penicillin was discovered, and its high efficacy in controlling Treponema confirmed. There was actually a reduction in the number of cases in the mid-1950s. Nevertheless, there was a significant increase starting in the 1960s, due probably to sexual liberation and the growing use of illicit drugs. A new reduction in the number of cases occurred again in the 1970s, due to public health campaigns. In the 1980s, a new growth in the number of cases was detected, strongly associated with the HIV epidemic around the world, sexual promiscuity and the sexual practices of men who have sex with men (MSM). At that time, increasing rates were also observed in heterosexual individuals who were associated with promiscuity, unprotected sexual practices and prostitution. Until today, despite many initiatives to reduce the number of cases, the infection rate in adults is alarming, particularly among pregnant women and newborns.
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The increased occurrence of syphilis during pregnancy, and its severe repercussions to the fetal environment, has been a cause for concern among health care professionals. It is hard to comprehend why congenital syphilis has not yet been controlled, since its agent, the spirochaete Treponema pallidum, is well known and is highly susceptible to penicillin, a low cost and easily available drug. When we compare the control of mother-to-child transmission (MTCT) of HIV with that of syphilis, it is even harder to understand why we have such success with the first one and disastrous results with the second!
When we evaluate the epidemiology of syphilis in pregnancy and in the general adult population, we notice that there were great expectations to eradicate this disease after WWII, when penicillin was discovered, and its high efficacy in controlling Treponema confirmed. There was actually a reduction in the number of cases in the mid-1950s. Nevertheless, there was a significant increase starting in the 1960s, due probably to sexual liberation and the growing use of illicit drugs. A new reduction in the number of cases occurred again in the 1970s, due to public health campaigns. In the 1980s, a new growth in the number of cases was detected, strongly associated with the HIV epidemic around the world, sexual promiscuity and the sexual practices of men who have sex with men (MSM). At that time, increasing rates were also observed in heterosexual individuals who were associated with promiscuity, unprotected sexual practices and prostitution. Until today, despite many initiatives to reduce the number of cases, the infection rate in adults is alarming, particularly among pregnant women and newborns.
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