Diverse Clinical Presentations and Treatment Challenges in Congenital Syphilis: Insights from a Case Series

Congenital syphilis (CS) remains a major public health concern, especially in low- and middle-income countries (LMICs). We present a series of six neonates with proven or possible CS, demonstrating varied presentations from asymptomatic seropositivity to periostitis and central nervous system (CNS) involvement. Due to the unavailability of standard penicillin therapy in two proven cases, ceftriaxone was used effectively. All infants showed favorable outcomes. This case series highlights the variable presentations of CS and the diagnostic challenges faced in clinical practice. The favorable outcomes in neonates treated with ceftriaxone, in the absence of standard penicillin therapy, support its consideration as a potential alternative in resource-limited settings.