• Etiologic agent: Treponema pallidum
  • Can be congenital or acquired
  • Consider sexual abuse when syphilis diagnosed in young children.
  • All confirmed cases should be reported to the local public health department.


  • Congenital syphilis
    • Approximately 12.4 cases per 100,000 live births in 2015 (487 cases), mostly among blacks
    • Case fatality rate 6%; 82% of deaths are stillborn.
    • Occurs via vertical transmission and mostly transplacental, but natal transmission possible by contact with infectious lesions at time of delivery
    • Fetal infection can occur at any time of gestation
  • Acquired syphilis
    • Sexually transmitted
    • Highest among men who have sex with men (MSM)
    • Often facilitates transmission and acquisition of HIV. All persons with syphilis should be tested for HIV.
    • Open, moist mucocutaneous lesions are highly infectious for up to 24 hours after institution of treatment.

Risk Factors

  • Congenital syphilis
    • Lack of prenatal care
    • Maternal use of illicit drugs
    • Maternal HIV infection
  • Acquired syphilis
    • MSM
    • HIV infection, especially among MSM
    • Illicit drug use (especially crack cocaine)
    • Sexual abuse

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