• Infectious diseases STIs soar more than 100%: "Globalization, social networks and the loss of condom use are increasing"

The increase in sexually transmitted infections (STIs) in recent years already has a clear consequence: their spread to vulnerable groups, in this case newborns. The tremendous escalation they are experiencing has become a phenomenon that reaches similar dimensions throughout Europe and the United States.

"The growth in congenital syphilis numbers reflects the reality of the nation's syphilis epidemic and the growing trend of infections among women and their sexual partners," said Robert McDonald of the Division of STI Prevention at the Centers for Disease Control and Prevention (CDC) in Atlanta. The US in an article published a year ago by The Lancet Microbe. "From 2015 to 2019, rates of primary and secondary syphilis increased more than 170% in women of reproductive age." However, two decades earlier this scenario was completely different, as the US was preparing to eradicate syphilis once and for all.

On the other side of the Atlantic, the scenario is similar. In 2019, 72 confirmed cases of congenital syphilis were reported in 13 EU countries, according to the latest records from the European Centre for Disease Prevention and Control (ECDC). This is the second consecutive year in a decade that the number of reported cases has increased (66 in 2018).

In Spain, STIs have increased 158.93% in women and 113.83% in men between 2016 and 2019, according to the most up-to-date data from the Carlos III Health Institute. In 2021, 6,613 cases of syphilis were reported and its incidence rate per 100,000 population has doubled in the last 10 years, to 13.97.

In Europe, the trend is similar and, in the US, the CDC in its latest report warns that syphilis cases skyrocketed in 2021, especially among women and a worrying increase in cases of congenital syphilis in babies, which can be deadly.

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In Spain the data do not seem to clearly reflect what we are seeing in hospitals, since we are treating more cases in recent years, "explains David Aguilera, spokesman for the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC).

According to the latest data recorded in Renave's February report, carried out by the Carlos III Institute, five confirmed cases of early congenital syphilis (under two years of age) were reported in 2021. The cases corresponded to three boys and two girls, all of them were diagnosed before the first month of life, except one of the girls who was diagnosed with 10 months. The incidence rate of confirmed cases in 2021 is 1.48, the fifth highest since 2000.

Congenital syphilis reaches the newborn through transmission of Treponema pallidum bacteria from mother to child. The likelihood of vertical transmission is directly related to the stage of maternal syphilis during pregnancy and/or the trimester of gestation in which the mother acquired the infection.

"An infection during gestation poses a risk to the fetus if there is transmission. We have seen an increase in cases in the last ten years, if you take into account that until a few years ago it was considered exceptional, because there had been a progressive decline." But now "we are showing an increase," says Aguilera.

Women between the ages of 25 and 34 have the highest rates of syphilis. This issue is supported by biological and behavioural reasons. On the one hand, it is related to the moment of experimentation in which young women with more sexual partners than older women are found, explain from the Spanish Society of Gynecology and Obstetrics (Sego). On the other hand, the biological, vaginal flora of women is changing at those ages, in addition, the area of metaplasia in the cervix in young women is larger being a perfect place for bacteria and viruses to canton.

The bacteria can remain latent in the woman and show her face at the time of routine analysis of the pregnant woman. "Sometimes, it can go unnoticed during pregnancy and give the face in the newborn baby," says Aguilera. This happens because the infection goes through several phases, in one of them they remain latent and without treatment or prophylactic measures can lead to serious complications and new infections.

There is primary syphilis characterized by the appearance of an ulcer at the site of infection (syphilitic chancre) two to three weeks after exposure. After this, a rash usually develops that usually affects the trunk and palms of the hands and soles of the feet, known as secondary syphilis).

After exposure of symptoms, the silent phase is reached, in which there is a period characterized by the absence of signs of disease, called latent syphilis. Here, it can coincide with the time of gestation. Without treatment the disease progresses and many years after acquisition can appear involvement of multiple organs, including severe vascular and nervous system damage, which is known as tertiary syphilis.

Symptoms of congenital syphilis in the baby

There are two scenarios by which the diagnosis is reached in the baby. "The most frequent is a detection during pregnancy of syphilis in different stages, in such a way that we establish the risk of transmission," explains the also assistant doctor of infectious pediatrics at the Gregorio Marañón University Hospital (Madrid). "It can also be due to a series of signs that the baby presents in the first weeks of life," he adds.

The clinical picture in the newborn is variable and there may be no symptoms at birth or manifest as rhinitis, mucocutaneous lesions, bone alterations, hepatosplenomegaly accompanied by jaundice and anemia in the first two years of life. From that age there may be ocular involvement, deafness and bone involvement among other manifestations. It can become a cause of miscarriage, neonatal death or infant death due to preterm birth or systemic disease.

Aguilera stresses the importance of early detection "because the involvement can be serious, and can affect neurological, hematological ... It can endanger the life of the fetus even before birth."

"It is necessary to monitor the evolution until the moment of delivery and establish the risk of transmission of the infection and it is checked at the time of delivery," explains Aguilera. Whether in the pregnant woman or in the baby, the therapeutic approach is through penicillin "at different doses and duration".

Curbing STIs "will lead to a decrease in infections in children. The risk is that congenital infections will also increase if those that occur in adults are not controlled, "says the doctor of Gregorio Marañón.

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