Category/stage
Adequate maternal treatment before pregnancy with low stable or negative titer AND infant exam is normal
What is congenital syphilis unlikely
Initial lab work
What is treponemal tests (microhemagglutination assay for T pallidum, the T pallidum particle agglutination, the T pallidum hemagglutination assay, the fluorescent treponemal antibody absorbed (FTA-ABS) test, and chemoluminescence immunoassays and enzyme immunoassays that detect Treponemal antibodies) AND nontreponemal tests (RPR titer)
Treatment for "congenital syphilis unlikely"
What is no treatment
Timeframe for repeat titers
What is repeat RPR titers every 3 months until titer becomes non-reactive
Adequate maternal treatment
What is penicillin treatment during pregnancy AND more than 4 weeks before delivery AND no concern for maternal reinfection or relapse
Mother adequately treated with infant RPR/VDRL not fourfold or greater than maternal RPR/VDRL
What is congenital syphilis less likely
Procedure and labs to obtain
What is lumbar puncture to get a CSF VDRL, protein, and cell count
Treatment for "congenital syphilis less likely"
What is Benzathine penicillin G 50,000 U/kg IM single dose
OR
If maternal titers decreased at least fourfold after appropriate treatment and remained stable at low titers then consider no treament
Age when RPR titer is expected to be negative
What is 6 months of age. If stable or increasing at 6-12 months then infant should be reevaluated and treated.
Signs of early congenital syphilis
What is rhinitis (“snuffles”), hepatosplenomegaly, skin rash with desquamation, chorioretinitis and pigmentary chorioretinopathy (salt and pepper type), glaucoma, cataracts, interstitial keratitis, optic neuritis, periostitis and cortical demineralization of metaphysis and diaphysis areas of long bones, anaemia and thrombocytopenia. Some clinical signs consistent with congenital syphilis – such as hydrops and hepatosplenomegaly – might be detected by ultrasound during pregnancy.
No maternal treatment or inadequate treatment with infant RPR/VDRL same or less than fourfold the maternal RPR/VDRL and normal exam
What is possible congenital syphilis
Imaging
What is long bone x-rays of all 4 extremities
Treatment for "possible congenital syphilis"
What is penicillin G 50,000 U/kg IV q12hr for 7 days then q8hrs for 3 days (10 days total)
OR
Penicillin G 50,000 U/kg IM daily for 10 days
Age when maternal antibodies should no longer be present
What is 15 months of age.
Signs of late congenital syphilis
What is saddle nose due to destruction of cartilage, frontal bossing due to periostitis, tibial thickening (saber shins), joint swelling (clutton joints), perforation of hard palate, abnormal tooth development (Hutchinson’s teeth, mulberry molars), interstitial keratitis, neurologic deafness and optic atrophy.
No maternal or treatment or inadequate treatment with infant RPR/VDRL fourfold or greater than maternal RPR/VDRL and exam is abnormal
What is proven or highly probable congenital syphilis
Additional lab work
What is CBC and LFTs
Treatment for "proven or highly probable congenital syphilis
What is penicillin G 50,000 U/kg IV q12hr for 7 days then q8hrs for 3 days (10 days total)
OR
Penicillin G 50,000 U/kg IM daily for 10 days
Other clinics/subspecialties that should be following infant/child for follow-up
What is ophthalmology, audiology, and neurology for yearly exams and development should be monitored closely
Significance of fourfold change in the titer
What is a fourfold change is the same as the change of two dilutions and is what is needed for a change in the titer to be considered significant and not random.