General Information. Pathogenesis

As early as the end of the 15th and the beginning of the 16th centuries it was noted that syphilis could be transmitted to the progeny. The mechanism of the transmission, however, remained disputable for several centuries. Though even then some physicians believed that the foetus could be infected with syphilis only by a syphilitic mother and that the infection is transmitted through the placenta, most physicians advocated the germinative hypothesis, claiming that the syphilitic infection is transmitted to the foetus only by the father through a spermatozoon infecting the ovum directly.

In 1903 the Viennese scientist Matzenauer contributed greatly to the substantiation of the theory of the maternal, placental transmission of syphilis to the progeny on the basis of long-term clinical observations. Universal recognition, however, was earned by this theory only after the serological methods of examination for syphilis (Wassermann's reaction) were introduced in practice.

T. pallidum is detected in the body of the foetus only in the second half of intrauterine life ( when placental circulation begins functioning ). In early miscarriages in syphilitic women the foetus has no syphilitic affection. It is believed that treponemas enter the body of the foetus either by the hematogenous (through the umbilical vein) or the lymphogenous (along the lymph slits of the umbilical cord) route.

Congenital syphilis mortality rate is in inverse proportion to the child's age, that is why social and prophylactic measures of congenital syphilis control acquire major importance. In contrast, congenital syphilis, especially the early form, is now an extremely rare occurrence in Ukraine, which is one of the major achievements of public health and the venereological service in particular.

It is considered possible that a mother suffering from congenital syphilis (syphilis of the second and even third generation) may give birth to children with syphilis. Such cases occur very rarely, however.

Pregnancy in a woman with untreated syphilis may terminate in late miscarriage or premature delivery of a dead child or a child with early manifestations of congenital syphilis. A healthy infant may be born of a mother who had received specific treatment (both before and during pregnancy) or of later pregnancies (the mother's property for transmitting syphilis to the progeny diminishes three to four years after infection, but is not lost completely). The longer the time from the moment of the mother's infection with syphilis, the less pronounced are the manifestations of congenital syphilis.

The following forms of true congenital syphilis are distinguished:

- syphilis of the placenta,

- syphilis of the foetus,

- early congenital syphilis (infantile congenital syphilis, congenital syphilis of early childhood,

- late congenital syphilis.

Some authors claim, however, that the syphilitic infection may also influence the chromosomal apparatus of the parents' germ cells. Various physical, neurological, and psychic, intellectual defects are found in these sick children. Organic and functional microsymptoms of affection of the nervous system are the neurological disorders. The psychic disorders include oligophrenia of various severity, psychopathic-like behaviour, encephalo-asthenic or schizophrenic-like syndrome, etc. The congenital pathological manifestations in these patients are not associated with the direct entry of T. pallidum into the body of the foetus and therefore cannot be referred to true congenital syphilis. Since there is no causative agent in the child's body in such cases, the serological reactions in blood and cerebrospinal fluid are always negative and antisyphilitic agents have no marked therapeutic effect. Psychiatrists and some venereologists, however, contend that these damages 'would never have occurred' if the parents or progenitors had not suffered from late forms of syphilis. The clinical symptoms and pathogenesis of these processes are still being studied. The latter is sometimes called parasyphilis.

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