DOCTORS should be on the lookout for syphilis in all pregnant women, according to new NHS guidelines.
Medics have noticed an "increasing number of diagnoses" of the medieval STI in both expectant mums and unborn babies.
Previously, healthcare professionals were on alert for rashes caused by rubella, parvovirus, measles, varicella, herpes, enterovirus and chickenpox.
But syphilis, which can cause reddish-brown spots, sores and warts, was added to the watch list on November 28, 2023.
GPs, midwives and other medical staff must now consider it as a possible diagnosis.
The guidelines state: "Rather than risk-assessing patients, it is recommended to test all pregnant women with a rash illness for syphilis."
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This usually involves a physical examination and swab and blood samples being taken.
The most common way to catch syphilis is through unprotected vaginal, anal or oral sex with someone who is infected, according to the NHS.
But it can also be passed on to an unborn baby during pregnancy, by injecting drugs with an infected needle, or during a blood or organ transplant.
Syphilis was first detected in the 1490s and remained a significant medical problem until the mid-20th century.
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But as treatments improved, syphilis cases reduced. They are now on the rise.
Diagnoses of infectious syphilis have doubled over the last decade, government data shows.
There were 8,692 cases in 2022 – the highest annual number reported since the 1940s. This compares to 7,543 the year before.
Most diagnoses are in gay, bisexual and other men who have sex with men, but there was a 27 per cent rise in women between 2021 and 2022.
This includes mums-to-be and their future children.
According to the Integrated Screening Outcomes Surveillance Service (ISOSS), 906 of the 650,000 pregnant women who were screened in 2020 tested positive for syphilis.
Several presented to healthcare providers with a rash but were not initially assessed as doing so was not included in official recommendations.
Almost half (43 per cent) of patients required treatment before they had given birth.
Most cases were found in London (229), followed by the Midlands (195), the North West (145), and the North East and Yorkshire (128).
Three of their children were admitted to hospital for congenital syphilis.
Figures show there were 39 babies born with confirmed congenital syphilis in England between January 1, 2015, and the end of 2021.
However, officials fear the true number could be much higher.
An ISOSS spokesperson said: "As this was a retrospective review, it is possible that numbers, particularly in the earlier period, may be under-reported."
Syphilis progresses in four stages:
- Primary stage – between two to 12 weeks after exposure (patients develops painless sores on the genitals that might heal on their own)
- Secondary stage – between one to six months after the primary stage (patients may develop itchy rashes on the skin)
- Latent stage (patients show no signs but remain infectious)
- Tertiary stage (patients may develop complications)
If treated, symptoms usually clear up within two months.
But a quarter of untreated patients will develop secondary syphilis, which usually involves a rash.
Typically, rashes appear during the secondary stage, which resolves in three to 12 weeks.
The risk of syphilis transmission to the feotus is higher in the second half of pregnancy.
It is estimated up to 40 per cent of babies with congenital syphilis are stillborn or die in their first four weeks of life.
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While easy to treat if caught early (when symptoms may present as sores, warts, rashes, hair loss and headaches), syphilis can be hugely damaging in the long-term.
It can cause heart failure, seizures, memory difficulties, personality changes, blindness and dementia if untreated, experts say.
Symptoms of syphilis and its stages
THE symptoms of syphilis are often mild, making them difficult to spot.
They also tend to change over time, and come and go, so it is easy to presume you aren't infected, even when you are.
The most common symptoms of the infection include:
- Small sores (ulcers) on your penis, vagina, or around your bottom (anus) – these are usually painless and you may only have one of them
- Sores in other areas, including in your mouth or on your lips, hands or bottom
- White or grey warty growths most commonly on your penis, vagina or around your anus
- A rash on the palms of your hands and soles of your feet that can sometimes spread all over your body – this is not usually itchy
- White patches in your mouth
- Flu-like symptoms, such as a high temperature, headaches and tiredness
- Swollen glands
- Patchy hair loss on the head, beard and eyebrows
These signs may not appear until three weeks (or more) after you're infected.
Sometimes the symptoms can improve or go away completely, but if you have not been treated the infection is still in your body.
This means you can still pass it on and you're at risk of getting serious problems later on.
Potential complications include:
- Heart problems like angina, aortic aneurysm and heart failure
- Brain problems like fits (seizures), memory problems, personality changes and dementia
- Nerve problems like shooting pains, pins and needles, joint pain and gradual damage the joints
- Problems with the skin, bones, testicles, liver and any other organ
Syphilis tends to happen in stages.
- Primary stage – between two to 12 weeks after exposure (patients develops painless sores on the genitals that might heal on their own)
- Secondary stage – between one to six months after the primary stage (patients may develop itchy rashes on the skin)
- Latent stage (patients show no signs but remain infectious)
- Tertiary stage (patients may develop complications)
Source: NHS and WHO
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