Abstract • Despite decades of experience with congenital syphilis, problems still arise in case definition, diagnostic evaluation, treatment, and follow-up. We reviewed all 50 cases of early congenital syphilis reported to the State of Texas in 1982. A large proportion of the infants were premature (39%), of low birth weight (38%), and symptomatic at birth (62%). Because of these findings, we believe that possible cases of asymptomatic congenital syphilis in Texas may be under-reported. Laboratory and/or roentgenographic findings were important to confirm the diagnosis of congenital syphilis. Over half of the asymptomatic infants had positive results of cerebrospinal fluid VDRLs. After diagnosis, the treatment of infants with penicillin varied considerably. While all 47 living Infants were treated with penicillin, 21 different regimens were used. We urge all physicians to perform complete diagnostic evaluations on suspected infants consisting of a quantitative serum test for syphilis, serum IgM levels, a cerebrospinal fluid VDRL, roentgenographs of the long bones, and dark-field microscopy where indicated. Additionally, infants and their families need appropriate follow-up after treatment. (AJDC 1985;139:575-580) References 1. Kaufman RE, Jones OG, Blount JH, et al: Questionnaire survey of reported early congenital syphilis: Problems in diagnosis, prevention and treatment . Sex Transm Dis 1977;4:135-139.Crossref 2. Mascola L, Pelosi R, Blount JH, et al: Congenital syphilis: Why is it still occurring? JAMA 1984;252:1719-1722.Crossref 3. Vital Statistics: A Method of Imputing Length of Gestation on Birth Certificates . Hyattsville, Md, National Center for Health Statistics, US Dept Health and Human Services publication (PHS) 82-1367, 1982. 4. Texas Health Department: Vital Statistics 1982 , Austin, Tex, Texas Health Department, 1983. 5. Rothman KJ, Boice JD: Epidemiologic Analysis With a Programmable Calculator . Boston, Epidemiology Resources Inc, 1982. 6. Platou R: Treatment of congenital syphilis with penicillin . Adv Pediatr 1949;4:39-84. 7. Gingrich RD, Drusin LM, Kavey RE: Early congenital syphilis . NY State J Med 1976;76:283-288. 8. Budell JW: Syphilis , in Wedgewood RJ, Davis SD, Ray CG, et al (eds): Infections in Children . Hagerstown, Md, Harper & Row Publishers Inc, 1982, pp 921-936. 9. Monif GR, Williams BR, Shulman ST, et al: The problem of maternal syphilis after serologic surveillance during pregnancy . Am J Obstet Gynecol 1973;117:268-270. 10. Srinivasan G, Ramamurthy RS, Bharathi A, et al: Congenital syphilis: A diagnostic and therapeutic dilemma . Pediatr Infect Dis 1983;2: 436-441.Crossref 11. Rathbun K: Congenital syphilis: A proposal for improved surveillance, diagnosis, and treatment . Sex Transm Dis 1983;10:93-99.Crossref 12. Alford CA, Polt SS, Cassady GE, et al: IM fluorescent treponemal antibody in the diagnosis of congenital syphilis . N Engl J Med 1969;208: 1086-1091.Crossref 13. Mascola L, Pelosi R, Alexander CE: Inadequate treatment of syphilis in pregnancy . Am J Obstet Gynecol 1984;150:945-947.Crossref 14. Laird SM: Failure to prevent congenital syphilis . Br J Vener Dis 1968;44:136-140. 15. Stokes JH, Beerman H, Ingraham NR: Modern Clinical Syphilology . Philadelphia, WB Saunders Co, 1954. 16. McCracken GH, Kaplan JM: Penicillin treatment for congenital syphilis: A critical reappraisal . JAMA 1974;228:855-858.Crossref 17. Robinson RCV: Congenital syphilis . Arch Dermatol 1969;99:599-610.Crossref 18. Thorley JD, Kaplan JH, Holmes RK, et al: Passive transfer of antibodies of maternal origin from blood to cerebrospinal fluid in infants . Lancet 1975;1:651-654.Crossref 19. Sexually transmitted diseases treatment guidelines 1982 . MMWR 1982;31:52s-53s. 20. Why the increasing incidence of syphilis , editorial. JAMA 1963;183:1104-1105. 21. Kass EH: Infectious disease and perinatal morbidity . Yale J Biol Med 1982;55:231-237.
American Journal of Diseases of Children – American Medical Association
Published: Jun 1, 1985