World Journal of Pediatrics

, Volume 6, Issue 2, pp 125–131 | Cite as

Congenital syphilis: still a serious, under-diagnosed threat for children in resource-poor countries

Original Article



With 700 000 to 1.5 million new cases annually, congenital syphilis remains a major infectious cause of morbidity and mortality in neonates, infants and children in resource-poor countries. We therefore analyzed the extent of congenital syphilis in the pediatric patient population at our rural hospital in Tanzania.


For this retrospective analysis, from January 1, 1998 to August 31, 2000, all cases of congenital syphilis were collected from the medical records of the neonatal and pediatric department at Haydom Lutheran Hospital in rural northern Tanzania. Age, sex, weight, clinical signs and symptoms, venereal disease research laboratory (VDRL) results of mother and/or child, hemoglobin concentration, treatment, and outcome were recorded and analyzed.


Fourteen neonates and infants were included. The earlier the diagnosis, the more it rested on maternal data because the presentation of neonatal congenital syphilis resembled neonatal sepsis. Syphilitic skin lesions were only seen in the post-neonatal age group. VDRL results were positive in 11 of the 14 mothers, and in 4 of the infants. Anemia was common in older infants. No patient showed signs of central nervous system involvement. Two patients died, and the remaining were cured after standard treatment with procaine penicillin.


Highlighting the variable picture of congenital syphilis, this report demonstrates how difficult it is to make a correct diagnosis by solely history and clinical presentation in a resource-poor setting. Hence false-positive and false-negative diagnoses are common, and clinicians have to maintain a high index of suspicion in diagnosing congenital syphilis. Therefore, an important approach to control and finally eliminate congenital syphilis as a major public health problem will be universal on-site syphilis screening of all pregnant women at their first antenatal visit and immediate treatment for those who test positive.

Key words

clinical diagnosis congenital syphilis prevention resource-poor countries universal screening 


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  1. 1.
    Bryce J, Boschi-Pinto C, Shibuya K, Black RE; WHO Child Health Epidemiology Reference Group. WHO estimates of the causes of death in children. Lancet 2005;365:1147–1152.CrossRefPubMedGoogle Scholar
  2. 2.
    UNICEF. Progress for children. A world fit for children. Statistical review no. 6. New York: UNICEF, 2007. (available at Scholar
  3. 3.
    Lawn JE, Wilczynska-Ketende K, Cousens SN. Estimating the causes of 4 million neonatal deaths in the year 2000. Int J Epidemiol 2006;35:706–718.CrossRefPubMedGoogle Scholar
  4. 4.
    Stanton C, Lawn JE, Rahman H, Wilczynska-Ketende K, Hill K. Stillbirth rates: delivering estimates in 190 countries. Lancet 2006;367:1487–1494.CrossRefPubMedGoogle Scholar
  5. 5.
    Roper MH, Vandelaer JH, Gasse FL. Maternal and neonatal tetanus. Lancet 2007;370:1947–1959.CrossRefPubMedGoogle Scholar
  6. 6.
    Walker DG, Walker GJ. Forgotten but not gone: the continuing scourge of congenital syphilis. Lancet Infect Dis 2002;2:432–436.CrossRefPubMedGoogle Scholar
  7. 7.
    Peeling RW, Mabey D, Fitzgerald DW, Watson-Jones D. Avoiding HIV and dying of syphilis. Lancet 2004;364:1561–1563.CrossRefPubMedGoogle Scholar
  8. 8.
    Schmid GP, Stoner BP, Hawkes S, Broutet N. The need and plan for global elimination of congenital syphilis. Sex Transm Dis 2007;34(7 Suppl):S5–10.PubMedGoogle Scholar
  9. 9.
    Schmid G. Economic and programmatic aspects of congenital syphilis prevention. Bull World Health Organ 2004;82:402–409.PubMedGoogle Scholar
  10. 10.
    UNAIDS. AIDS epidemic update: December 2007. Geneva: UNAIDS, 2007. (available at Scholar
  11. 11.
    Centers for Disease Control and Prevention. Congenital syphilis—United States, 2002.MMWR Morb Mortal Wkly Rep 2004;53:716–719.Google Scholar
  12. 12.
    Gust DA, Levine WC, St Louis ME, Braxton J, Berman SM. Mortality associated with congenital syphilis in the United States, 1992–1998. Pediatrics 2002;109:E79.CrossRefPubMedGoogle Scholar
  13. 13.
    Doroshenko A, Sherrard J, Pollard AJ. Syphilis in pregnancy and the neonatal period. Int J STD AIDS 2006;17:221–227.CrossRefPubMedGoogle Scholar
  14. 14.
    Chakraborty R, Luck S. Syphilis is on the increase: the implications for child health. Arch Dis Child 2008;93:105–109.CrossRefPubMedGoogle Scholar
  15. 15.
    Enders M, Knaub I, Gohl M, Pieper I, Bialek C, Hagedorn HJ. Congenital syphilis despite prenatal screening? An evaluation of 14 cases. Z Geburtshilfe Neonatol 2006;210:141–146.CrossRefPubMedGoogle Scholar
  16. 16.
    Saloojee H, Velaphi S, Goga Y, Afadapa N, Steen R, Lincetto O. The prevention and management of congenital syphilis: an overview and recommendations. Bull World Health Organ 2004;82:424–430.PubMedGoogle Scholar
  17. 17.
    Hawkes S, Miller S, Reichenbach L, Nayyar A, Buses K. Antenatal syphilis control: people, programmes, policies and politics. Bull World Health Organ 2004;82:417–423.PubMedGoogle Scholar
  18. 18.
    WHO. The global elimination of congenital syphilis: rationale and strategy for action. Geneva: WHO, 2007. (available at Scholar
  19. 19.
    Hossain M, Broutet N, Hawkes S. The elimination of congenital syphilis: a comparison of the proposed World Health Organization action plan for the elimination of congenital syphilis with existing national maternal and congenital syphilis policies. Sex Transm Dis 2007;34(7 Suppl):S22–30.PubMedGoogle Scholar
  20. 20.
    Swai RO, Somi G GR, Matee MI, Killewo J, Lyamuya EF, Kwesigabo G, et al. Surveillance of HIV and syphilis infections among antenatal clinic attendees in Tanzania-2003/2004. BMC Public Health 2006;6:91.CrossRefPubMedGoogle Scholar
  21. 21.
    Olsen BE. Motherhood—a hazardous endeavour. Maternal deaths and urinary tract infections in pregnancy in rural northern Tanzania. Doctoral thesis. Bergen: Centre for International Health, Faculty of Medicine, University of Bergen, 2002.Google Scholar
  22. 22.
    Haydom Lutheran Hospital. Haydom Lutheran Hospital—Annual reports 1998–2007. Haydom: Haydom Lutheran Hospital, 1999–2008.Google Scholar
  23. 23.
    Hinderaker SG, Krüger C, Evjen Olsen B, Naman N, Bergsjø P, Evjen Olsen OH. Low HIV-seroprevalence in pregnant women in a rural area in Tanzania. Acta Obstet Gynecol Scand 2001;80:1152–1153.PubMedGoogle Scholar
  24. 24.
    Darville T. Syphilis. Pediatr Rev 1999;20:160–164.CrossRefPubMedGoogle Scholar
  25. 25.
    Woods CR. Syphilis in children: congenital and acquired. Semin Pediatr Infect Dis 2005;16:245–257.CrossRefPubMedGoogle Scholar
  26. 26.
    Gichangi P, Renterghem LV, Karanja J, Bwayo J, Kiragu D, Temmerman M. Congenital syphilis in a Nairobi maternity hospital. East Afr Med J 2004;81:589–593.PubMedGoogle Scholar
  27. 27.
    Frank D, Duke T. Congenital syphilis at Goroka Base Hospital: incidence, clinical features and risk factors for mortality. P N G Med J 2000;43:121–126.PubMedGoogle Scholar
  28. 28.
    Hira SK, Bhat GJ, Patel JB, Din SN, Attili RV, Patel MI, et al. Early congenital syphilis: clinico-radiologic features in 202 patients. Sex Transm Dis 1985;12:177–183.PubMedCrossRefGoogle Scholar
  29. 29.
    Peeling RW, Ye H. Diagnostic tools for preventing and managing maternal and congenital syphilis: an overview. Bull World Health Organ 2004;82:439–446.PubMedGoogle Scholar
  30. 30.
    Moyer VA, Schneider V, Yetman R, Garcia-Prats J, Parks D, Cooper T. Contribution of long-bone radiographs to the management of congenital syphilis in the newborn infant. Arch Pediatr Adolesc Med 1998;152:353–357.PubMedGoogle Scholar
  31. 31.
    Beeram MR, Chopde N, Dawood Y, Siriboe S, Abedin M. Lumbar puncture in the evaluation of possible asymptomatic congenital syphilis in neonates. J Pediatr 1996;128:125–129.CrossRefPubMedGoogle Scholar
  32. 32.
    Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2002. MMWR Recomm Rep 2002;51(RR-6):1–78.Google Scholar
  33. 33.
    Goh BT, van Voorst Vader PC; European Branch of the International Union against Sexually Transmitted Infection and the European Office of the World Health Organization. European guideline for the management of syphilis. Int J STD AIDS 2001;Suppl 3:14–26.Google Scholar
  34. 34.
    Beksinska ME, Mullick S, Kunene B, Rees H, Deperthes B. A case study of antenatal syphilis screening in South Africa: successes and challenges. Sex Transm Dis 2002;29:32–37.CrossRefPubMedGoogle Scholar
  35. 35.
    Yahya-Malima KI, Evjen-Olsen B, Matee MI, Fylkesnes K, Haarr L. HIV-1, HSV-2 and syphilis among pregnant women in a rural area of Tanzania: prevalence and risk factors. BMC Infect Dis 2008;8:75.CrossRefPubMedGoogle Scholar
  36. 36.
    Riedner G, Rusizoka M, Todd J, Maboko L, Hoelscher M, Mmbando D, et al. Single-dose azithromycin versus penicillin G benzathine for the treatment of early syphilis. N Engl J Med 2005;353:1236–1244.CrossRefPubMedGoogle Scholar
  37. 37.
    Zhou P, Qian Y, Xu J, Gu Z, Liao K. Occurrence of congenital syphilis after maternal treatment with azithromycin during pregnancy. Sex Transm Dis 2007;34:472–474.CrossRefPubMedGoogle Scholar
  38. 38.
    National Bureau of Statistics (NBS) [Tanzania] and ORC Macro. Tanzania Demographic and Health Survey 2004–05. Daressalaam, Tanzania: National Bureau of Statistics and ORC Macro, 2005. (available at Scholar
  39. 39.
    Sheffield JS, Sanchez PJ, Morris G, Maberry M, Zeray F, McIntire DD, et al. Congenital syphilis after maternal treatment for syphilis during pregnancy. Am J Obstet Gynecol 2002;186:569–573.CrossRefPubMedGoogle Scholar
  40. 40.
    Richardson MP, Palfreeman A, Nielsen PB, Fenton KA. Congenital syphilis following negative antenatal screening. Commun Dis Public Health 2002;5:72–73.PubMedGoogle Scholar
  41. 41.
    Peeling RW, Holmes KK, Mabey D, Ronald A. Rapid tests for STIs: the way forward. Sex Transm Infect 2006;82(Suppl 5):v1–v6.CrossRefPubMedGoogle Scholar
  42. 42.
    Garcia SG, Tinajeros F, Revollo R, Yam EA, Richmond K, Diaz-Olavarrieta C, et al. Demonstrating public health at work: a demonstration project of congenital syphilis prevention efforts in Bolivia. Sex Transm Dis 2007;34(7 Suppl):S37–S41.PubMedGoogle Scholar
  43. 43.
    Gloyd S, Montoya P, Floriano F, Chadreque MC, Pfeiffer J, Gimbel-Sherr K. Scaling up antenatal syphilis screening in Mozambique: transforming policy to action. Sex Transm Dis 2007;34(7 Suppl):S31–S36.PubMedGoogle Scholar
  44. 44.
    Bronzan RN, Mwesigwa-Kayongo DC, Narkunas D, Schmid GP, Neilsen GA, Ballard RC, et al. Onsite rapid antenatal syphilis screening with an immunochromatographic strip improves case detection and treatment in rural South African clinics. Sex Transm Dis 2007;34(7 Suppl):S55–60.PubMedGoogle Scholar
  45. 45.
    Schackman BR, Neukermans CP, Fontain SN, Nolte C, Joseph P, Pape JW, et al. Cost-effectiveness of rapid syphilis screening in prenatal HIV testing programs in Haiti. PLoS Med 2007;4:e183.CrossRefPubMedGoogle Scholar
  46. 46.
    Mullick S, Broutet N, Htun Y, Temmerman M, Ndowa F. Controlling congenital syphilis in the era of HIV/AIDS. Bull World Health Organ 2004;82:431–432.PubMedGoogle Scholar

Copyright information

© Children's Hospital, Zhejiang University School of Medicine and Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  1. 1.Department of PediatricsSt. Franziskus HospitalAhlenGermany
  2. 2.Haydom Lutheran HospitalHaydom via MbuluTanzania
  3. 3.Centre for International Health, School of Public HealthCurtin University of TechnologyPerthAustralia
  4. 4.Department of PediatricsSt. Franziskus HospitalAhlenGermany

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