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Pathogenesis

  • Transmission to the fetus is transplacental, it can also occur during delivery in the presence of maternal genital lesions.[1][2][3]
  • The risk of transmission to the fetus is dependent on the stage of the maternal disease(dependent on the spirochete concentration in the blood stream) and the duration of exposure to the fetus in utero.[4]
  • The risk of vertical transmission of syphilis from an infected untreated mother decreases as maternal disease duration progresses: transmission risk of 70–100% for primary syphilis and 40% for early latent syphilis to 10% for late latent disease. The variation in the percentages with the duration of infection is because the concentration of spirochetes in the blood stream decrease with the duration of maternal syphilis infection.[5]
  • Kassowitz's law describes the an inverse relationship of interval between the disease and pregnancy. Longer the interval between infection and pregnancy more benign is the outcome.[6]
  • Transmission of infection typically takes place between the 16th and 28th week of pregnancy, however the transmission can be as early as the first trimester of pregnancy.[7][8][9][10][11][12]
  • Inadequate antenatal care
  • Multiple sexual partners
  • Prostitution
  • Illicit drug use
  • Unprotected sex
  • Residence in highly prevalent areas
  • HIV infection
  • Presence of other STIs
  • Previous history of STIs
  • Intravenous drug use
  • Health care professionals who are predisposed to occupational risk
  • Low socioeconomic status
  • Wicher V, Wicher K (2001). "Pathogenesis of maternal-fetal syphilis revisited.". Clin Infect Dis. 33 (3): 354–63. PMID 11438902. doi:10.1086/321904. 
  • Domingues RM, Leal Mdo C (2016). "[Incidence of congenital syphilis and factors associated with vertical transmission: data from the Birth in Brazil study].". Cad Saude Publica. 32 (6). PMID 27333146. doi:10.1590/0102-311X00082415. 
  • Peeling RW, Hook EW (2006). "The pathogenesis of syphilis: the Great Mimicker, revisited.". J Pathol. 208 (2): 224–32. PMID 16362988. doi:10.1002/path.1903. 
  • Berman SM (2004). "Maternal syphilis: pathophysiology and treatment.". Bull World Health Organ. 82 (6): 433–8. PMC 2622860Freely accessible. PMID 15356936. 
  • Genç M, Ledger WJ (2000). "Syphilis in pregnancy". Sex Transm Infect. 76 (2): 73–9. PMC 1758294Freely accessible. PMID 10858706. 
  • Balaji G, Kalaivani S (2013). "Observance of Kassowitz law-late congenital syphilis: Palatal perforation and saddle nose deformity as presenting features.". Indian J Sex Transm Dis. 34 (1): 35–7. PMC 3730472Freely accessible. PMID 23919053. doi:10.4103/0253-7184.112869. 
  • Zhou H, Chen XS, Hong FC, Pan P, Yang F, Cai YM; et al. (2007). "Risk factors for syphilis infection among pregnant women: results of a case-control study in Shenzhen, China.". Sex Transm Infect. 83 (6): 476–80. PMC 2598725Freely accessible. PMID 17675391. doi:10.1136/sti.2007.026187. 
  • Hook EW, Peeling RW (2004). "Syphilis control--a continuing challenge.". N Engl J Med. 351 (2): 122–4. PMID 15247352. doi:10.1056/NEJMp048126. 
  • Buchacz K, Greenberg A, Onorato I, Janssen R (2005). "Syphilis epidemics and human immunodeficiency virus (HIV) incidence among men who have sex with men in the United States: implications for HIV prevention.". Sex Transm Dis. 32 (10 Suppl): S73–9. PMID 16205297. 
  • Solomon MM, Mayer KH (2015). "Evolution of the syphilis epidemic among men who have sex with men.". Sex Health. 12 (2): 96–102. PMC 4470884Freely accessible. PMID 25514173. doi:10.1071/SH14173. 
  • Hakre S, Arteaga GB, Núñez AE, Arambu N, Aumakhan B, Liu M; et al. (2014). "Prevalence of HIV, syphilis, and other sexually transmitted infections among MSM from three cities in Panama.". J Urban Health. 91 (4): 793–808. PMC 4134449Freely accessible. PMID 24927712. doi:10.1007/s11524-014-9885-4. 
  • Newell, J., et al. "A population-based study of syphilis and sexually transmitted disease syndromes in north-western Tanzania. 2. Risk factors and health seeking behaviour." Genitourinary medicine 69.6 (1993): 421-426.

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