CONGENITAL SYPHILIS (CS) CASE INVESTIGATION
ALGORITHM
4.Appropriate response to therapy is a
fourfold decline in non-treponemal titer by three months with primary or secondary
syphilis, or a fourfold decline in non-treponemal titer by six months with
early latent syphilis.An inappropriate response is less
than a fourfold drop over the expected time period unless the patient is
knownto be serofast (see below). An equivocal response includes instances where
it was difficult to assess adequate response because either no interim titers
from treatment to delivery were available or insufficient time had passed between
treatment and delivery. An unknown response includes those instances where
titers before treatment and/or at delivery are not available. The infant/child
of a mother with an equivocal or unknown response should be evaluated for CS.
1.For
the case definition of congenital syphilis (CS), the mother must have evidence
of syphilis by one of thefollowing tests:
(a) a
syphilitic lesion at the time of delivery proven by positive darkfield or
direct fluorescentantibody
(DFA) examination; or (b) a
reactive treponemal test (e.g., FTA-ABS, MHA-TP). A treponemal test on the mother may
not be available for an infant evaluated outside the newborn period or a child
with late CS. In these instances, the investigation may proceed on the basis of
infant/child treponemal and nontreponemal tests. An attempt to obtain a
maternal treponemal test should be made.
2.Adequate therapy in a
non-pregnant woman should be one of the standard treatment regimens
recommended for her particular stage of infection .
3.Adequate therapy in a pregnant
woman is treatment with a penicillin regimen, appropriate for the
mother’s stage of syphilis, started at least 30 days before delivery (see STD
Treatment Guidelines). Any non-penicillin treatment or penicillin treatment in
the last 30 days of pregnancy is inadequate for the unborn child.
Special consideration is required
in the case of a serofast patient. If a mother’s titer was 1:1, 1:2, or 1:4 before
pregnancy, there is evidence of adequate treatment, and at delivery her titer
is still the same low level, she should be regarded as serofast. Stop the case
investigation; this is not a case.
5.A
syphilitic stillbirth is defined as a fetal death in which the mother
had untreated or inadequately treated syphilis at delivery of a fetus after a
20-week gestation or weighing >500 grams.
6.Signs
of CS (usually in an infant or child <2 years old) include:
condyloma lata, snuffles, syphilitic skin rash, hepatosplenomegaly, jaundice
due to syphilitic hepatitis, pseudoparalysis, or edema (nephrotic syndrome
and/or malnutrition). Stigmata in an older child may include: interstitial
keratitis, nerve deafness, anterior bowing of shins, frontal bossing, mulberry
molars, Hutchinson’s teeth, saddle nose, rhagades, or Clutton’s joints.
7.In
the immediate newborn period, interpretation of these tests may be
difficult; normal values vary with gestational age and are higher in preterm
infants. CSF cell count and protein in a term or preterm infant should be interpreted
by the clinician. Beyond the neonatal period, a CSF cell count >5 wbc/mm 3
or a CSF protein >40 mg/dl is abnormal, regardless of CSF serology.
Source: CDC,USA
Treatment of syphilis: follows
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