ConditionChildren's health
TORCH Infections
TORCH infections are a group of infections that can pass from a pregnant person to the baby during pregnancy or birth and cause birth defects or illness in the newborn. TORCH stands for Toxoplasmosis, Other (including syphilis, chickenpox, parvovirus B19, Zika and HIV), Rubella, Cytomegalovirus (CMV) and Herpes simplex. They can cause miscarriage, poor growth, hearing loss, eye and brain problems, jaundice and rash. Vaccination, screening, hygiene and treatment in pregnancy prevent many cases.
Also called: TORCH complex, congenital TORCH infections, perinatal infections, TORCHES (with syphilis), congenital infections
At a glance
- What they are
- Infections passed to the baby before or during birth.
- The letters
- Toxoplasmosis, Other (syphilis, varicella, parvovirus, Zika, HIV, others), Rubella, CMV, Herpes.
- Most common in the US
- Congenital CMV, a leading non-genetic cause of hearing loss.
- Effects
- Miscarriage, stillbirth, growth restriction, small head, hearing and vision loss, developmental delay, rash, jaundice.
- Prevention
- Rubella and chickenpox vaccination before pregnancy, syphilis and HIV screening, hygiene, food safety.
When to get help
Call 911 or go to the ER
- A newborn with fever, poor feeding, extreme sleepiness, seizures, or blisters on the skin, eyes or mouth (possible neonatal herpes)
See a doctor within a day or two
- A rash, fever or flu-like illness during pregnancy, or contact with someone with chickenpox, rubella or measles if not immune
- Genital sores or blisters during late pregnancy
- A newborn with jaundice in the first 24 hours, a rash of tiny bruises, or failed hearing screen
Book a routine appointment
- Planning pregnancy: check immunity to rubella and chickenpox
- Questions about cats, food safety, or working with young children during pregnancy
The TORCH infections
| Infection | How it spreads to the parent | Possible effects on the baby |
|---|---|---|
| Toxoplasmosis | Undercooked meat, unwashed produce, cat feces, soil | Eye inflammation (chorioretinitis), hydrocephalus, brain calcifications, seizures |
| Syphilis | Sexual contact | Stillbirth, rash, bone problems, liver enlargement, snuffles |
| Varicella (chickenpox) | Respiratory droplets, contact | Limb, skin scarring and eye defects (early pregnancy); severe newborn chickenpox (near delivery) |
| Parvovirus B19 | Respiratory droplets, often from children | Severe fetal anemia and swelling (hydrops) |
| Zika virus | Mosquitoes, sexual contact | Microcephaly and brain abnormalities |
| HIV | Blood, sexual contact | HIV infection in the baby (largely preventable with treatment) |
| Rubella | Respiratory droplets | Congenital rubella syndrome: deafness, cataracts, heart defects |
| Cytomegalovirus (CMV) | Saliva and urine of young children, sexual contact | Hearing loss, microcephaly, developmental delay, vision problems |
| Herpes simplex | Genital herpes, usually during birth | Skin, eye and mouth blisters, brain infection, widespread infection |
Signs in the newborn
Many babies infected before birth have no signs at birth. When present, signs can include:
- small size for gestational age
- small head (microcephaly)
- rash, including "blueberry muffin" spots or tiny bruises (petechiae)
- jaundice and an enlarged liver or spleen
- seizures
- cataracts or eye inflammation
- heart murmurs
- hearing loss (sometimes appearing later)
Testing
- Routine prenatal screening in the US includes syphilis, HIV, hepatitis B and rubella immunity.
- Targeted testing for CMV, toxoplasmosis, parvovirus or varicella when there are symptoms, exposure, or abnormal ultrasound findings.
- Ultrasound can detect signs such as poor growth, brain changes or fluid buildup.
- Amniocentesis can test for some infections in the baby.
- Newborn testing: urine or saliva PCR for CMV within 3 weeks of birth; blood, eye and brain assessments as needed; hearing screening.
A "TORCH panel" blood test is less used now because results are often hard to interpret; specific tests for specific infections are preferred.
Treatment
- Syphilis: penicillin in pregnancy prevents most congenital syphilis.
- HIV: antiretroviral treatment during pregnancy and for the newborn reduces transmission to under 1%.
- Toxoplasmosis: spiramycin or pyrimethamine-based treatment in pregnancy and for affected infants.
- Herpes: antivirals from 36 weeks for people with genital herpes, and cesarean delivery if active lesions are present at labor; IV acyclovir for infected newborns.
- Varicella: varicella zoster immunoglobulin after exposure in non-immune pregnant people; antivirals in some cases.
- Parvovirus: monitoring for fetal anemia; intrauterine transfusion if severe.
- CMV: valganciclovir for babies with symptomatic congenital CMV may improve hearing and development.
Prevention
- confirm immunity to rubella and chickenpox before pregnancy and vaccinate if needed (these vaccines are not given during pregnancy)
- practice safer sex and get screened for syphilis and HIV
- wash hands after changing diapers, wiping noses or handling toys of young children; avoid sharing cups and utensils with toddlers (reduces CMV)
- cook meat thoroughly, wash produce, and avoid handling cat litter (toxoplasmosis)
- avoid travel to Zika-risk areas and use mosquito protection
- tell your provider about any rash or exposure during pregnancy
Frequently asked questions
What does TORCH stand for?
TORCH stands for Toxoplasmosis, Other infections (such as syphilis, chickenpox, parvovirus, Zika and HIV), Rubella, Cytomegalovirus and Herpes simplex. These infections can pass to a baby during pregnancy or birth.
What is the most common TORCH infection?
In the US and many other countries, congenital cytomegalovirus (CMV) is the most common. It is a leading cause of hearing loss in children that is not genetic.
How can I protect my baby from TORCH infections?
Get vaccinated against rubella and chickenpox before pregnancy, have recommended screening for syphilis and HIV, wash hands after contact with young children's saliva or urine, avoid undercooked meat and cat litter, and report any rash or exposure.
What is a TORCH test?
A TORCH test traditionally checked for antibodies to several of these infections. Today, doctors usually order specific tests based on symptoms, exposure or ultrasound findings, because a broad panel can be difficult to interpret.
Sources
This guide was written from current patient and clinical guidance, including:
- CDC: Congenital CMV; Toxoplasmosis and pregnancy; Congenital syphilis; Rubella in pregnancy
- American College of Obstetricians and Gynecologists: Practice Bulletin 151: Cytomegalovirus, parvovirus B19, varicella zoster, and toxoplasmosis in pregnancy
- American Academy of Pediatrics: Red Book (congenital infections)
- MedlinePlus: Congenital infections
- March of Dimes: Infections during pregnancy