What is the greatest risk to acquire congenital syphilis?

The greatest risk for acquiring congenital syphilis is when a pregnant person with syphilis goes untreated or inadequately treated during pregnancy. The risk of transmitting syphilis to the fetus is highest when the infection in the pregnant person is not detected and managed properly. Several factors contribute to this risk:

1. **Lack of Prenatal Care**: When pregnant individuals do not receive prenatal care, they miss out on essential screenings for syphilis, which can lead to undiagnosed and untreated infections.

2. **Late or Inadequate Treatment**: If syphilis is diagnosed during pregnancy but is not promptly or adequately treated with appropriate antibiotics, the bacterium (Treponema pallidum) can still be present in the pregnant person's body and may be transmitted to the fetus.

3. **Primary or Secondary Syphilis in Pregnancy**: The risk of transmission is higher if the pregnant person is in the primary or secondary stage of syphilis, as the bacterial load is typically higher during these stages. Late-stage syphilis in the mother carries a lower risk of transmission to the fetus.

4. **Reinfection**: A pregnant person who was previously treated for syphilis but becomes reinfected with the bacterium during pregnancy is at increased risk of transmitting the infection to the fetus.

5. **Partner's Status**: If a pregnant person's sexual partner(s) has syphilis or is at risk of syphilis, it can increase the likelihood of syphilis transmission during pregnancy.

To reduce the risk of congenital syphilis, it is crucial for pregnant individuals to receive early and comprehensive prenatal care, including syphilis screening as part of routine prenatal testing. If syphilis is diagnosed during pregnancy, immediate and appropriate treatment with antibiotics, such as penicillin, is essential to prevent the transmission of the infection to the fetus. Regular follow-up and monitoring during pregnancy are also important to ensure that treatment is effective and that the pregnancy is progressing without complications related to syphilis.

Timely and effective management of syphilis during pregnancy is the key to preventing congenital syphilis and its associated risks to the newborn.