Evaluation and treatment of congenital syphilis

As of this writing, a total of 941 cases of congenital syphilis have been reported in 1989 to the Centers for Disease Control (CDC), a 95% increase from 1987 and the highest yearly total since the introduction of penicillin. However, because of the implementation of routine maternal serologic screening during pregnancy and at delivery, it is now uncommon in the United States to encounter a child with classic signs of late congenital syphilis. Currently, the most common challenge is evaluation of the symptom-free infant born to a mother with a positive result on a serologic screening test for syphilis. The pediatrician must assess the maternal treatment regimen for adequacy of treatment of infection in the fetus, and must determine the need to treat an infection that may not be clinically apparent in the newborn infant. The management of these infants is complicated by the lack of major clinical trials evaluating recommended therapies for syphilis in pregnant patients and in newborn infants. Published reports of individual treatment failures have formed the basis of renewed concerns about central nervous system involvement in early syphilis and about treatment efficacy of benzathine penicillin G in infants and ,in patients with acquired immunodeficiency syndrome.