Syphilis, early congenital

A50.9

*Notifiable condition.

DESCRIPTION

Multi-organ infection caused by T. pallidum and acquired by vertical transmission via the transplacental route during pregnancy.

DIAGNOSTIC CRITERIA

Clinical

  • Suspect if mother has syphilis or positive serology for syphilis and the baby a positive non-treponemal serological test at birth with a titre at least 4-fold higher than that of the mother.
  • Large, pale, greasy placenta.
  • The following signs may be present at birth or will develop within the first 3 months of life:
    • hydrops fetalis,
    • thrombocytopaenia,
    • anaemia,
    • lymphadenopathy,
    • hepatosplenomegaly,
    • jaundice,
    • oedema,
    • hypoalbuminaemia,
    • condylomata,
    • pneumonia alba,
    • hepatitis,
    • meningitis,
    • nephrosis/nephritis,
    • interstitial keratitis, and
    • transient bullous lesions, commonly on the hands and feet with later desquamation and an erythematous appearance of palms and soles.
  • A generalised, reddish, maculopapular rash that may desquamate.
  • Rhinitis with mucopurulent bloodstained discharge excoriating the upper lip.
  • Other mucocutaneous lesions of the mouth, anus and genitalia, healing with scars, especially the corners of the mouth and on the chin.
  • Involvement of long bones with/without pseudoparalysis of one or more limbs and radiological findings.

Investigations:

If mother is positive for syphilis:

  • X-ray of long bones:
    • translucent metaphyseal bands,
    • osteochondritis,
    • osteitits, and
    • metaphysitis and periostitis.
  • Confirm syphilis with:
    • Non-treponemal serological tests, i.e. RPR, VDRL, in mother and baby.
      Do not use umbilical cord blood at delivery for laboratory investigations.

GENERAL AND SUPPORTIVE MEASURES

  • Nurse infant in a neutral thermal environment.
  • Maintain adequate nutrition and hydration.
  • Monitor hepatic and renal function.
  • Ensure maternal and paternal treatment if positive.

Pneumonia

To maintain oxygen saturation at 90-94% or PaO2 at 60-80 mmHg:

  • Oxygen via a head box or nasal cannulae.
    1 kPa = 7.5 mmHg
    1 mmHg x 0.133 = 1 kPa

Anaemia

If Haematocrit < 40% (Hb < 13 g/dL):

  • Packed red cells, 10 mL/kg administered over 3 hours.

MEDICINE TREATMENT

Asymptomatic, well baby

Mother seropositive or result unknown, and mother has not been treated or was only partially treated:

  • Benzathine benzylpenicillin (depot formulation), IM, 50 000 units/kg as a single dose into the antero-lateral thigh.

Symptomatic baby

  • Procaine penicillin, IM, 50 000 units/kg daily for 10 days (not for IV use).
    OR
  • Benzylpenicillin (Penicillin G), IV, 50 000 units/kg 12 hourly for 10 days.

CAUTION
Procaine penicillin and benzathine benzylpenicillin must not be given intravenously.

Follow up children at 3 months post treatment with repeat non-treponemal serological tests, until test becomes non-reactive. Re-treat if drop in titre less than 4-fold.

Prevention

Screen pregnant women for syphilis at first visit and repeat during the second and/or third trimester.
Investigate and treat both parents, if necessary.

REFERRAL

  • Symptomatic infant with complications, e.g. respiratory failure, hepatic failure, nephrotic syndrome and meningitis.