Congenital syphilis revisited
L. Mascola, R. Pelosi, J. H. Blount, C. E. Alexander and W. Cates Jr
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.
