We report on two infants with typical features of symptomatic congenital syphilis in one hospital in Northern Italy, where no cases had occurred in the preceding 5 years. The occurrence of congenital syphilis is a failure of preventive public health interventions because penicillin treatment of the mother virtually abolishes the risk of syphilis in the newborn.5
It is recognised that early detection of syphilis and treatment of infection in pregnant women and their sexual partners is cost‐beneficial and cost‐effective in controlling maternal and congenital syphilis.6
However, the effectiveness of the present control strategies have recently been questioned.7
Both the infants we describe were borne to untreated women. In the first case, the mother did not receive treatment despite reactive serology, and in the second case the mother was not screened at all. Both mothers had latent syphilis of unknown duration. Although the risk of vertical transmission of syphilis is as high as 70% when the mother has primary or secondary syphilis or is in the first 4 years of infection,1
a transmission rate of 10% is also estimated in late latent syphilis.5
- This report suggests that the incidence of congenital syphilis is rising in Italy as a consequence of the re‐emergence of acquired syphilis among women.
- Testing strategies for syphilis among clandestine immigrants in Western Europe need to be strengthened.
- Skills to diagnose and treat neonates and infants with symptomatic congenital syphilis are necessary in Western European countries.
- Surveillance of congenital syphilis in Europe should be established.
Diagnosis of congenital syphilis may be difficult because clinical manifestations can involve several organs,8
their severity may vary significantly, and because of limited awareness of the disease among healthcare providers. Our first case was not recognised at birth, and diagnosis was later elicited by bony lesions, accompanied by liver and haematological manifestations. In the second case, the baby was severely ill at birth, with mucocutaneous manifestations, bony lesions, liver and haematological abnormalities, and involvement of the central nervous system.
This report cannot confirm, but does suggest, that the incidence of congenital syphilis is rising in Italy as a consequence of the re‐emergence of acquired syphilis among women. The number of cases of congenital syphilis in Europe is unclear because no specific surveillance system is in place.9
The two cases we describe occurred in women originating from Eastern Europe and the Balkans. A recent study has provided evidence that recent migration dynamics from Eastern Europe are associated with a resurgence of asymptomatic congenital syphilis in Italy.10
Our report further suggests that symptomatic congenital syphilis may also be on the rise. In Italy, antenatal care services are ensured by law regardless of the legal status of the mother; this provides healthcare practitioners with appropriate tools to tackle the health implications of migration from areas where syphilis prevalence is high. Indeed, both mothers described here had adequate access to antenatal care facilities. What is still needed is greater awareness of the importance of syphilis screening (ie, case 2) and adequate skills in interpreting syphilis serology and prescribing treatment (ie, case 1).
In summary, to meet the WHO European target for congenital syphilis,11
current control strategies for syphilis in pregnancy need to be urgently reviewed, and immigrant women should receive screening irrespective of their legal status. Active surveillance of the disease would also help to increase awareness about its relevance as a public health problem. Finally, although congenital syphilis is currently rare, clinicians should be able to diagnose and treat it adequately.