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Syphilis in pregnancy

Errol R Norwitz, MD, PhD, MBA
Charles B Hicks, MD
Section Editors
Charles J Lockwood, MD, MHCM
Noreen A Hynes, MD, MPH, DTM&H
Deputy Editors
Vanessa A Barss, MD, FACOG
Jennifer Mitty, MD, MPH


Syphilis is a systemic infection caused by the spirochete Treponema pallidum, which is of particular concern during pregnancy because of the risk of transplacental infection of the fetus. Congenital infection can be associated with several adverse outcomes, including perinatal death.

Issues related to syphilis during pregnancy will be reviewed here. Syphilis in children and nonpregnant adults are discussed separately. (See "Congenital syphilis: Clinical features and diagnosis" and "Congenital syphilis: Evaluation, management, and prevention" and "Syphilis: Epidemiology, pathophysiology, and clinical manifestations in HIV-uninfected patients" and "Syphilis: Treatment and monitoring".)


In the United States, the rate of primary and secondary syphilis in women increased from 1.1 cases per 100,000 females in 2014 to 1.4 cases per 100,000 females in 2015 to 1.9 cases in 2016 [1], a 35.7 percent increase in the last year of reporting. Increases in syphilis among women is often followed by increases in congenital syphilis cases as most cases are in reproductive-aged women.

After a steady decline, the rate of congenital syphilis has also increased 86.9 percent between 2012 and 2016, with 15.7 cases per 100,000 live births reported in 2016. Congenital syphilis rates (cases per 100,000 live births) among infants by maternal race/ethnicity were: black (43.1), American Indian/Alaska Native (31.6), Hispanic (20.5), Asian/Pacific Islander (9.2), and white (5.3).


Syphilis occurs with equal frequency in men and women worldwide [2], but men are more commonly infected in the United States. It is more common among pregnant women who are poor, young (age <29 years), African American, and lack health insurance and prenatal care. Other risk factors include use of illicit drugs, infection with other sexually transmitted diseases, residence in an area of high syphilis prevalence, and being a sex worker [3,4].

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Literature review current through: Nov 2017. | This topic last updated: Dec 06, 2017.
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