Placenta Non Grata: A Rare Presentation of a Reemerging Disease
Abstract
Background: Maternal syphilis rates in the United States have risen dramatically, from 87.2 per 100,000 births in 2016 to 357.9 per 100,000 births in 2024, according to Centers for Disease Control and Prevention (CDC) reports. Congenital syphilis rates have also been on the upswing, increasing from 60.0 to 109.6 per 100,000 births between 2020 and 2024, with cases on the rise for the twelfth consecutive year. This trend poses a pressing public health concern. Diagnosing syphilis, particularly in pregnancy, can be challenging due to its variable and often nonspecific presentation. Delayed recognition and treatment, however, can result in severe maternal and fetal complications.
Case report: We report a 28-year-old patient in her third trimester of pregnancy who presented to a rural emergency department (ED) with abdominal cramping, malodorous vaginal discharge, fever, hypotension, and altered mental status concerning for sepsis secondary to intrauterine infection. Pertinent social history included homelessness, an absence of prenatal care, and substance use. Fetal distress ultimately necessitated emergent delivery, after which testing confirmed maternal syphilis infection and congenital syphilis in the neonate. Later histopathologic analysis of the placenta revealed spirochete invasion consistent with syphilitic chorioamnionitis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Histopathologic confirmation of syphilitic chorioamnionitis is seldom available to emergency…
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