3. Definition:
• Congenital syphilis occurs when Treponema pallidum
• Transmitted from an infected mother to the fetus via
• placenta or
• during birth.
• Can cause severe complications,
• Including stillbirth, prematurity, and multi-organ damage.
4. Clinical Manifestations
• Early Congenital Syphilis (Birth to 2 Years)
• Symptoms typically appear within the first 3 months
• Skin & Mucous Membranes
• Rash (palms & soles)
• Mucous patches
• Desquamation (peeling skin)
• Snuffles (blood-stained nasal discharge) → highly infectious
6. Clinical Manifestations
• Late Congenital Syphilis (>2 Years, Untreated Cases)
• Hutchinson Triad:
• Hutchinson teeth (notched incisors)
• Interstitial keratitis
• Vision loss
• Sensorineural hearing loss
• Saber shins (bowed tibia)
• Frontal bossing
• Saddle nose deformity
• Clutton joints (painless symmetrical knee swelling)
7. Diagnosis
Serology (Mother & Baby):
• Nontreponemal tests: RPR or VDRL (quantitative, monitor response)
• Treponemal tests: FTA-ABS, TP-PA (confirmatory)
• Infant’s titer should be 4x the maternal titer for true infection
CSF Analysis (Neurosyphilis Suspected):
• VDRL, WBC count, protein level
Other Tests:
• Long bone X-rays (osteochondritis, periostitis)
• CBC (anemia, thrombocytopenia)
• LFTs (hepatitis)
8. Treatment
First-line:
Aqueous Penicillin G
50,000 units/kg IV q12h (first 7 days), then q8h for 10 days
Alternative (if compliance is a concern but no neurosyphilis):
Procaine Penicillin G 50,000 units/kg IM daily for 10 days
If Treatment is Incomplete (>1 day missed):
Restart the entire 10-day course
9. Follow-up
• Repeat VDRL/RPR every 2-3 months
• Should decline by 6-12 months
• Monitor for neurosyphilis signs
10. Reference
• Nelson textbook of pediatrics 22nd
edition
• CDC sexually transmitted infection treatment guideline
• Uptodate 3.70.4,2024
