Medical Resources :: Common Diseases :: Infectious Diseases & Parasites :: Syphilis

Syphilis is a very common disease in Eastern Europe, and cases of syphilis are increasing rapidly. Therefore, it is possible that a child's medical report may list exposure to syphilis (sometimes translated as Lues, an older term for syphilis) as a medical condition, or it may simply state that the mother was known to have syphilis.

History of an Epidemic

Due to political, social and economic factors in Eastern Europe today, many men and women have experienced significant declines in health. Since the restructuring of the former Soviet Union, poverty and unemployment have increased. Health care systems have been stretched to the limit, and drug and alcohol use has also increased.

There is now an epidemic of syphilis in Eastern Europe, and those at greatest risk are adolescent and young adult women and men. Between 1990 and 1996, syphilis rates increased 48-fold among Russians, and among teenagers it increased 68-fold. Syphilis cases have also skyrocketed in Belarus, Moldova and Ukraine since 1990. It is not surprising, therefore, that many mothers whose children are up for adoption may have a history of syphilis.

What is Syphilis?

Syphilis is a sexually transmitted disease (STD). It is fairly common throughout the world, in the US as well as in Eastern Europe. If a person has been tested and knows they have syphilis, it is easily treated with penicillin or other antibiotic. Although syphilis is serious, if detected and treated early, it can be completely cured.

What is Congenital Syphilis?

Congenital syphilis occurs in children whose mothers have had syphilis while they were pregnant. When a pregnant woman has syphilis that has not been treated, she may transmit the infection to her baby. Twenty percent of babies with congenital syphilis are stillborn or die in the first few weeks of life. About 60% of babies with congenital syphilis have no symptoms at birth. Most babies (80%) are diagnosed before 3 months of age, although symptoms can appear any time in the first 2 years. Congenital syphilis can also be completely cured if detected and treated early.

Treatment of Syphilis

If a pregnant woman is known to have syphilis, she should be treated with penicillin. This significantly reduces the chances of transmitting the infection to her baby. If a pregnant woman has syphilis and has not been treated, her baby should be treated with intravenous penicillin for 10-14 days after birth (intramuscular penicillin can be used as well in certain circumstances), which is standard treatment in the US.

In Russia, women attending maternity hospitals for their prenatal care are routinely tested for syphilis and treated before giving birth. Russian children in orphanages who are born to mothers with past syphilis which has already been treated are given 30 days of daily intramuscular injections of penicillin because the doctors are unable to determine the difference between acute and past infection by the blood work. This treatment is quite effective, but treatment failure can occur if the treatment was incomplete or the medicine was old.

What Should Adoptive Parents Do?

Before adoption:

If a child has "exposure to syphilis" listed on his or her medical record, parents should inquire as to whether the mother was treated, or the child was treated for syphilis at birth. If both were treated, this lessens the risk of the child getting syphilis. If either the mother or child's treatment is unknown, this increases the risk of syphilis exposure.

After Adoption:

The child should be tested for syphilis (RPR and FTA-ABS) and examined carefully by a pediatrician when he or she arrives in the home country. If a child tests positive for either or both of these tests, a pediatric infectious disease doctor should be consulted to interpret the test results. Congenital syphilis can be difficult to diagnose in young children. Tests for syphilis do not always definitively diagnose the difference between actual infection in the baby and simply the presence of antibodies to syphilis that pass from mother to baby during the pregnancy. If a child was possibly exposed to syphilis, hearing and vision screening should be conducted, as these systems may have been affected by the syphilis infection.

Experience with Adopted Children

Dr. Jane Aronson is an infectious disease pediatrician and Director of the International Pediatric Health Services, PLLC in New York. Dr. Aronson reviews 80-100 medical reports of children from Eastern Europe a month, and at least one-third of all reports mention exposure to syphilis. In her practice, she sees about 200 children adopted from Eastern Europe each year; thus far, seven children have had positive antibodies for syphilis indicating past exposure, but none of the children actually had acute syhilis at the time of their evaluation. All of the children had hearing and vision screening which were normal as well.

Recently, Dr. Aronson heard from a family who adopted a 17-month old girl who tested positive for syphilis upon return to the US (both RPR and FTA-ABS were positive). According to her medical report, she had been treated as an infant with 28 days of intramuscular penicillin and her syphilis tests in Russia were all negative. The girl was admitted to the hospital in the US for 10 days of intravenous penicillin. She tolerated the treatment well and she is a completely healthy child.

"This really drives home the message that syphilis tests must be repeated in the home country when the child first arrives," said Dr. Aronson. "It also shows how essential parents are as advocates for their children. The pediatrician did not want to do the syphilis tests and actually fought with the mother a bit, but the mother insisted"

Is "Exposure to Syphilis" a Concern?

Today, because syphilis is easily and frequently diagnosed in Russia, and because pregnant women and babies are almost always treated adequately for syphilis, "exposure to syphilis" is only a small concern for adoptive parents. However, the public health situation in Eastern Europe is changing rapidly.

"I am not as worried about syphilis as I used to be when I first started as an adoption medicine specialist six years ago," said Dr. Aronson. "I want parents to understand the possibilities of exposure, but I don't want parents to be discouraged from adopting a child who has been exposed to syphilis. It is essential that the child have both tests for syphilis when they arrive home. I want pediatricians and family doctors who take care of children adopted from abroad to know how important it is to test for syphilis when a child first arrives in the home country. There will be children who do test positive for acute syphilis and who will require treatment when they arrive home."

The situation with syphilis diagnosis and treatment in other Eastern European countries is generally similar to that of Russia, although there is greater knowledge of procedures in Russia, and more experience with children adopted from Russia.

One possible concern of an "exposure to syphilis" diagnosis is a result of the treatment children undergo. Intramuscular injections of penicillin are very painful and may cause some tactile defensiveness in children. In addition, reusing needles could be a potential source of transmission for hepatitis and HIV although disposable needles are commonly used in Russia

Other Concerns

There are other potential concerns associated with a syphilis diagnosis in the mother. The epidemic of syphilis in Eastern Europe is closely associated with drug and alcohol use, as well as with HIV infection and hepatitis B and C infection.

To date, Dr. Aronson has seen no cases of HIV in her practice in the children adopted from Eastern Europe. Almost all children in orphanages in Eastern Europe are tested for HIV and hepatitis before they are made available for adoption, and adoptive parents should request all test results for their children. However, Eastern European blood tests should not be considered that reliable. There have been some cases of hepatitis B among a small percentage of children who tested negative in their country of origin. HIV and hepatitis B and C tests should be repeated once the child arrives in the home country. Hepatitis B and C tests should be repeated six months after the initial test in the home country because of the lengthy incubation periods.

If parents have questions or concerns about a child's medical record, it is important to have medical records, photographs and videos evaluated by a doctor or other specialist who has experience with internationally adopted children. (link to list of doctors who review videotapes).

Links to further information:

Vanderbilt Medical Center description of Congenital Syphilis
   http://www.mc.Vanderbilt.Edu/peds/pidl/infect/congsyph.htm

Johns Hopkins University STD Research Group
   http://www.med.jhu.edu/jhustd/syphilis.htm

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