A diagnosis of congenital syphilis is very difficult to
establish because clinical signs of infection may not be apparent and many
times the blood test are unreliable. Syphilis is a sexually transmitted disease
that is transmitted form the mother to the infant via the placenta.
Fortunately, if this disease is discovered during the prenatal visits it can be
easily treated with Penicillin. Untreated maternal infection in the early
stages of the pregnancy can lead to significant fetal morbidity whereas
infection in the later part of the pregnancy can produce a symptomatic infant.
The two most commonly used screening tests for syphilis are
(1) VDRL: is useful for screening and follow-up of known cases and (2) RPR:
used for screening. All screening tested need to be confirmed with a more
specific test called the FTA-ABS that can verify current or past infection. If
this test is positive then the likelihood of having the infection is pretty
good and needs to be treated.
The causes for the false positive results on the initial
screening test can be secondary other medical conditions such as: (aging,
pregnancy, mononucleosis, hepatitis, IV drug addiction, and some autoimmune
disorder like lupus). Another reason for a false positive screening test or
(VDRL or RPR) it may represent passively transferred antibody from the mother
and not actual congenital infection. In cases where it is believed that the
positive test result is from passive maternal transfer in the absence of active
infection, it is required to follow-up with serial measurements of VDRL and
they should reduce to normal values by a couple of weeks.
Like in adults this infectious disease is easily treatable
with inject able penicillin.
Infants with a positive confirmatory serology for syphilis
should be evaluated fully.
A complete history of the maternal disease and therapy is
mandatory. The infant needs to have a complete blood count done, liver function
test; long bone x-rays, spinal fluid examinations.
Treatment needs to be given to infants with:
1) Whose mother’s were inadequately treated?
2) Mother’s who received treatment less than one month prior
3) Mother’s who were given other medications other than
4) Mother’s who had undocumented or a poor blood testing
response to treatment.
If the mother had received adequate therapy and there are no
clinical or laboratory signs present, this infant may be followed without
therapy but needs to have serial monthly blood tests performed. Rising titers
or clinical signs usually develop by 4 months in infected infants.
Infants with proved or suspected congenital syphilis require
treatment with injectable penicillin every6- 8 hours for 14 days.
Newborns: usually symptomatic but when signs do develop
after a few weeks they are, Jaundice (yellowing of the skin), anemia (low blood
levels), large liver and edema or swelling. Some may even have severe signs of
meningitis or infection of the spinal fluid.
Young Infants: normal for first few weeks and then develop
skin lesions, and a paralysis of the arms or legs. There is usually an enlarged
liver or spleen, and like the newborns there is anemia. “Snuffles” (rhinitis or
continuous runny nose) with a thick mucous drainage that excoriates the upper
lip is found sometimes. A syphilitic rash usually occurs on the palms and feet
but may occur anywhere on the body. They look like bright red spots that
Syphilis in the young infant may lead to stigmatas
recognizable in later childhood
1) Rhagades: scars around the mouth and nose
2) Depressed nasal bridge (saddle nose)
3) Permanent upper teeth peg shaped with a central notch ( Hutchinson teeth)
4) High forehead secondary to low grade meningitis
Children: (untreated with spinal fluid meningitis
1) Eye problems and infections
2) Deafness, mental retardation
3) Speech defects
4) Bone manifestations
1) Severe disease if undiagnosed may be fatal to a newborn.
2) Complete cure can be obtained if young infant is given
3) Treatment of primary syphilis with penicillin is curative
4) Blood test reversal occurs within one year
5) Permanent neurological sequelae occur only with severe
Questions that you need to ask?
1) What test were performed and at what ages? Where they
repeated or confirmed?
2) Was the mother treated during the pregnancy with
3) Was the infant treated with penicillin and for how long?
Was it injectable?
4) What if any follow-up testing was performed?
By George Rogu M.D.
Medical Director and Founder of Adoptiondoctors.com
The information and advice provided is intended to be
general information, NOT as advice on how to deal with a particular child's
situation and or problem. If your child has a specific problem you need to ask
your pediatrician about it - only after a careful history and physical exam can
edical diagnosis and/or treatment plan be made. This Web
site does not constitute a physician-patient relationship.