Special Presentations of Syphilis

• Neurosyphilis may arise in context of secondary or less commonly tertiary syphilis.
• It can result in meningitis, visual, auditory and other neurological and cognitive impairment.
• Neurosyphilis should be considered in patients with cognitive impairment and movement disorders.
• The diagnosis of neurosyphilis should always be done in consultation with an appropriate specialist.

Note: the following signs and symptoms may or may not be present in syphilis cases. Syphilis signs and symptoms vary from patient to patient, with some patients being asymptomatic at all stages.

Congenital syphilis is a syphilis infection affecting a baby in the uterus or shortly after delivery. Syphilis can be transmitted from pregnant person to baby during pregnancy and delivery. The transmission risk is extremely high in early infectious syphilis (90-100% transmission in primary or secondary syphilis) and decreases over time but can still occur many years after the initial infection if not successfully treated. How syphilis affects the baby depends on when the pregnant person was infected and therefore at what stage in pregnancy the infection is transmitted.

Complications of congenital syphilis may include:

• mid-term miscarriage
• death in utero (before birth)
• stillbirth
• bone and organ damage of the baby
• blindness of the baby

Babies infected in late pregnancy or delivery may have no clinical abnormalities evident at birth but will likely present with congenital syphilis within the first few years of life if not managed appropriately at birth.

The diagnosis of congenital syphilis is difficult and should always be done in consultation with an appropriate specialist.

Congenital syphilis can be prevented if the pregnant person is treated >30 days before delivery.

Due to the increasing number of congenital syphilis cases, national guidelines advise that pregnant people should be screened at least THREE times in EACH pregnancy:

1. at the first antenatal visit
2. at 26-28 weeks,
3. and at 36 weeks or birth (whichever is earlier)

Some pregnant people may be at greater risk of syphilis and require additional tests. Additionally, the Northern Territory and some regions recommend additional universal and risk-based testing for syphilis in pregnancy.

Refer to Testing in antenatal care section to view national and jurisdictional syphilis testing in pregnancy guidelines

⚠ View clinical images – this section contains images of genitalia and medical procedures

Image credit: Centres for Disease Control and Prevention