Congenital Infections (TORCH Infections)

What TORCH means

TORCH is an acronym for the classic congenital infections:

Doctors now often prefer to test for specific infections based on the situation rather than ordering a broad "TORCH screen", which can give misleading results.

The main infections

Cytomegalovirus (CMV)

The most common congenital infection in the US and a leading cause of non-genetic hearing loss in children. Mothers usually catch it from young children's saliva and urine. Most infected babies look normal at birth, but about 1 in 5 develops long-term problems, especially hearing loss that may appear later.

Syphilis

Congenital syphilis has increased dramatically in the US over the past decade. It can cause stillbirth, newborn death, rash, bone problems, enlarged liver and spleen, and later developmental problems. It is fully preventable: testing in pregnancy and treatment with penicillin cures the mother and protects the baby.

Toxoplasmosis

A parasite from undercooked meat or cat litter. Infection early in pregnancy is less likely to reach the baby but more harmful if it does. Many babies have no symptoms at birth but develop eye problems later.

Rubella

Infection in the first trimester can cause congenital rubella syndrome: deafness, cataracts, heart defects and intellectual disability. It is now rare in countries with high MMR vaccination.

Herpes simplex

Usually transmitted during vaginal delivery, especially when the mother has a first genital herpes infection near birth. Neonatal herpes can cause skin and eye sores, brain infection or widespread infection, typically in the first 4 weeks of life.

Other important infections

• Varicella (chickenpox): in early pregnancy can cause limb and skin scarring; near delivery can cause severe newborn chickenpox.
• Zika virus: can cause microcephaly and brain abnormalities.
• HIV and hepatitis B: passed mainly at birth; treatment in pregnancy and newborn vaccines or medicines greatly reduce transmission.
• Parvovirus B19: can cause severe anemia and fluid buildup in the fetus.
• Group B strep: not a TORCH infection, but a major cause of newborn infection at birth; prevented by screening and antibiotics in labor.

Signs in newborns

Some babies have no signs at birth. Possible signs include:

• low birth weight or poor growth
• small head (microcephaly) or brain abnormalities
• jaundice and enlarged liver or spleen
• rash, including small purple-red spots ("blueberry muffin" rash) or blisters
• eye problems: cataracts, inflammation of the retina
• failed newborn hearing screen
• seizures, poor feeding, floppiness
• heart defects (rubella)

Diagnosis

During pregnancy

Routine prenatal blood tests check for syphilis, HIV and hepatitis B, and rubella immunity. Other tests are done when there is exposure or symptoms. Ultrasound may show signs of fetal infection, and amniocentesis can confirm some infections.

In the newborn

• CMV: urine or saliva PCR in the first 3 weeks of life; some states screen all newborns
• syphilis: blood tests compared with the mother's results, plus examination and sometimes X-rays and spinal fluid tests
• herpes: swabs, blood and spinal fluid PCR
• toxoplasmosis: antibody tests, eye exam and brain imaging
• hearing tests, eye exams and brain ultrasound or MRI

Treatment

• Syphilis: penicillin for the mother in pregnancy, and for the baby if needed.
• CMV: valganciclovir for babies with symptomatic infection may improve hearing and developmental outcomes, started within the first month.
• Toxoplasmosis: antiparasitic medicines in pregnancy and for the baby.
• Herpes: IV acyclovir for the newborn; antiviral medicine late in pregnancy and cesarean delivery in some situations.
• HIV and hepatitis B: antiretroviral treatment in pregnancy; newborn medicines, hepatitis B vaccine and immune globulin.
• Ongoing care: hearing aids or cochlear implants, vision care, developmental therapy.

Prevention

• Vaccinate before pregnancy: MMR (rubella) and varicella vaccines are given at least 1 month before conceiving, not during pregnancy.
• Prenatal testing for syphilis, HIV and hepatitis B, repeated later in pregnancy where risk is higher.
• Hand hygiene: wash hands after changing diapers, feeding young children or wiping their noses; avoid sharing cups, utensils and kissing toddlers on the mouth to reduce CMV risk.
• Food safety: cook meat thoroughly, wash fruit and vegetables, avoid unpasteurized dairy.
• Cats: have someone else change the litter box; wear gloves for gardening.
• Safer sex and partner testing for syphilis, herpes and HIV.
• Avoid travel to Zika-affected areas during pregnancy.

Frequently asked questions

What are TORCH infections?

TORCH stands for toxoplasmosis, other infections (such as syphilis, chickenpox, Zika and HIV), rubella, cytomegalovirus and herpes simplex. These infections can pass from mother to baby during pregnancy or birth and may cause birth defects, hearing or vision loss and other problems.

What is the most common congenital infection?

Cytomegalovirus (CMV) is the most common congenital infection in the US, affecting about 1 in 200 babies. Most infected babies seem healthy at birth, but some develop hearing loss or developmental problems, so early testing matters.

How can I prevent infections that harm my baby during pregnancy?

Get vaccinated against rubella and chickenpox before pregnancy, attend prenatal testing, wash hands after contact with young children's saliva or diapers, cook meat thoroughly, avoid cat litter, practice safer sex and avoid Zika areas.

Can congenital infections be treated?

Many can. Syphilis is cured with penicillin, CMV and herpes can be treated with antivirals, toxoplasmosis with antiparasitic medicines, and HIV and hepatitis B transmission can be largely prevented. Some damage that occurs before birth cannot be reversed, but early treatment improves outcomes.

Does a TORCH screen test for everything?

No. A TORCH screen measures antibodies to a few infections and can be hard to interpret. Doctors usually prefer targeted tests based on symptoms and exposures, such as CMV PCR on a newborn's urine or specific syphilis tests.