A Clinical Review of Congenital and Perinatal Infections: From Womb to Follow-Up

The acronym "TORCH" was originally introduced in 1974 by Dr Nahmias to collectively describe the most common pathogens responsible for congenital and perinatal infections, including Toxoplasma gondii, others, rubella virus, cytomegalovirus (CMV), and herpes simplex virus. With advances in diagnostic capabilities and expanded epidemiologic surveillance, the list of recognized congenital pathogens has grown to include syphilis, varicella-zoster virus, Zika virus, HIV, parvovirus B19, and lymphocytic choriomeningitis virus. While the TORCH acronym continues to be widely used in clinical and educational settings, it no longer encompasses the full spectrum of pathogens implicated in perinatally acquired and in utero infections. A more nuanced and inclusive approach to the diagnosis and management of congenital infections is required. These vertically transmitted pathogens can disrupt fetal development, leading to outcomes ranging from subclinical disease to severe neurologic impairment, sensorineural hearing loss, or fetal demise. Epidemiologic trends vary globally: CMV is more prevalent in low-income countries, while congenital rubella is rare in regions with successful vaccination programs. The Zika virus outbreak underscored the need for early recognition of emerging threats to fetal health. Despite their potentially serious consequences, TORCH infections are frequently underdiagnosed due to nonspecific clinical presentations, diagnostic limitations, and inconsistencies in screening practices. Misinterpretation of serologic results and delays in diagnosis may lead to preventable complications. This review synthesizes current evidence on TORCH infections, emphasizing clinical manifestations, diagnostic strategies, therapeutic approaches, and long-term follow-up. A proposed multidisciplinary model aimed at improving perinatal screening and neonatal outcomes is offered.