Congenital Syphilis - CPS Statement

Question 1

When should pregnant women be screened for syphilis?

Answer 1

First prenatal visit

If high risk:
Repeat at 28 - 32 weeks gestation
At delivery

Question 2

What are the 2 types of syphilis testing?

Answer 2

RPR or VDRL - initial screen, used for titres to monitor treatment effectiveness

Treponemal test - includes TP-PA, FTA-ABS, also enzyme immunoassay (EIA), line-blot immunoassay (INNO-LIA). Will be positive for life after initial infection unless treated very early in disease course.

Question 3

What is the expected RPR decline with adequate therapy for maternal primary syphilis?

Answer 3

Four­fold drop (e.g., from 1:32 dilutions to 1:8 dilutions) at six months, an eightfold drop at 12 months and a 16-fold drop at 24 months with primary syphilis

Question 4

What is the expected RPR decline with adequate therapy for maternal secondary syphilis?

Answer 4

an eightfold drop at six months and a 16-fold drop at 12 months with secondary syphilis

Question 5

What is the expected RPR decline with adequate therapy for maternal latent syphilis?

Answer 5

fourfold drop at 12 months with early latent syphilis

Question 6

What are potential features of congenital syphilis present at birth? Hint: eight features

Answer 6

1) Necrotizing funisitis of umbilical cord
2) Rhinitis or sniffles
3) Rash (onset in 1st eight weeks)
4) Hepatomegaly/splenomegaly
5) Lymphadenopathy
6) Neurosyphilis
7) MSK involvement - bony changes
8) Hematologic changes

Question 7

What are the potential MSK signs of congenital syphilis (which are present in infancy)?

Answer 7

Osteochondritis or perichondritis, seen initially radiographically (25% of cases) and later as pseudoparalysis, which can be confused with child abuse as there are both bony and of tissue limb changes.

Question 8

What are the facial features that can develop in congenital syphilis?

Answer 8

Frontal bossing, poorly developed maxillas, saddle nose

Question 9

What are “Clutton’s joints” in congenital syphilis?

Answer 9

Recurrent arthropathy and painless knee effusions

Question 10

What dental anomalies can be present with congenital syphilis? (Hint: there are 2)

Answer 10

Hutchinson’s teeth: upper central and lateral incisors widely spaced and shaped like screwdrivers

Mulberry molars: first molars have dwarfing of the cusps and hypertrophy of the enamel surrounding the cusp, giving it the appearance of a berry

Question 11

What hematologic anomalies can be present in congenital syphilis?

Answer 11

Anemia
Thrombocytopenia

Question 12

What ocular issues can be a consequence of congenital syphilis?

Answer 12

Interstitial keratitis (occurring generally from age 2 - 20)

Question 13

What cranial nerve can be affected as a consequence of congenital syphilis?

Answer 13

Eighth nerve deafness
(sensory neural deafness)

Question 14

How would primary syphilis present in a mother?

Answer 14

Solitary, painless chancre

Question 15

How would secondary syphilis present in a mother?

Answer 15

Secondary syphilis can have a wide variety of symptoms, especially fever, lymphadenopathy, rash, and genital or perineal condyloma latum

Question 16

You have treated a baby for congenital syphilis - when do they require repeat RPR titres?

Answer 16

0, 3, 6 and 18 months of age

Question 17

What is the treatment of choice for suspected congenital syphilis? (include dose and dosing interval)

Answer 17

10-day course of IV crystalline penicillin G of 50,000 units/kg given every 12 h to infants younger than one week of age, every 8 h to infants one to four weeks of age and every 6 h to infants older than four weeks of age

Question 18

If an infant does NOT have congenital syphilis or did have congenital syphilis and was adequately treated, by which age should their TPPA revert to negative?

Answer 18

18 months

Question 19

If initial CSF parameters were abnormal, when should the LP be repeated?

Answer 19

Obtain CSF every 6 months until normal

Question 20

You have an infant whose mother was adequately treated for late latent syphilis. When should you do serologies for this infant?

Answer 20

0, 6 and 18 months

Question 21

You have an infant whose mother was treated for primary, secondary or early latent syphilis during pregnancy more than four weeks before delivery, with adequate fall in her RPR titres and no evidence of relapse or reinfection. When do you repeat serologies for this infant? How often do you examine?

Answer 21

0, 3, 6 and 18 months

Baseline P/E, repeat assessment at 1, 2, and 3 months

Question 22

You have an infant whom you are following with serial VDRL testing. At 6 months, the infant has a positive VDRL (and TT). What do you do?

Answer 22

Full workup and likely treatment