Congenital Syphilis

Clinical description

• 60–90% of infants with congenital syphilis have no signs at birth; signs may appear weeks or months later.
• Early congenital (under 2 years): rash on palms/soles, enlarged liver/spleen, jaundice, bone/joint swelling, snuffles (bloody nasal discharge), failure to thrive, meningitis ± seizures.
• Late congenital (usually age 5–15): Hutchinson's teeth, corneal inflammation, hearing loss, intellectual disability, bone/joint deformities, gummas.
• Transmission in utero; breastfeeding transmission only if open sores on mother's breast.

Treatment

Presumed congenital syphilis: mother syphilis rapid test positive AND mother not/insufficiently treated (treatment started within 30 days of delivery, incomplete, or non-penicillin regimen), OR infant with any clinical syphilis signs. Wear gloves when examining neonates — lesions are highly infectious.

Confirmed or presumed congenital syphilis

• Aqueous benzyl penicillin 100,000–150,000 U/kg/day IV for 10–15 days.
• OR procaine penicillin 50,000 U/kg/day IM OD for 10–15 days.

Expect good response to penicillin but recovery of severely ill infants may take weeks/months. Review infants without signs at 1 and 2 months. A positive syphilis rapid test in a previously untreated child ≥ 12 months old is likely active syphilis — treat as early or late congenital syphilis. Treat the mother and all sexual partners for early or late syphilis.