Category | Findings | Recommended Evaluation | Treatment |
|---|
Proven or highly
probable congenital
syphilis | - Abnormal physical examination consistent with congenital syphilis
OR - A serum quantitative nontreponemal serologic titer fourfold (or greater) higher than the birthing parent’s titer at delivery (eg, maternal titer = 1:2, neonatal titer >=1:8; or maternal titer = 1:8, neonatal titer >=1:32)
OR - A positive result of darkfield test or PCR assay of lesions or body fluid(s)
| - CSF analysis (CSF VDRL, cell count, and protein)
- CBC with differential and platelet count
- Other tests (as clinically indicated):
- Chest radiography
- Aminotransferases
- Neuroimaging
- Ophthalmologic examination
- Auditory brain stem response
- HIV testing
| - Aqueous crystalline penicillin G, 50 000 U/kg, IV, every 12 hours (1 wk or younger), then every 8 h for infants older than 1 wk, for a total of 10 days of therapyb (preferred)
OR - Penicillin G procaine, 50 000 U/kg, IM, as single
daily dose for 10 days
|
Possible
congenital
syphilis | - Normal infant examination
AND - A serum quantitative nontreponemal serologic titer less than fourfold the birthing parent’s titer at delivery (eg, maternal titer = 1:8, neonatal titer ≤1:16)
AND ONE OF THE FOLLOWING - Birthing parent was not treated, was inadequately treated, or had no documentation of receiving treatment;
OR - Birthing parent was treated with a regimen other than recommended in the guideline (ie, a nonpenicillin G regimen)
OR - Birthing parent received recommended regimen but treatment was initiated <30 days before delivery
| - CSF analysis (CSF VDRL, cell count, and protein)
- CBC with differential and platelet count
- Long-bone radiography
| - Aqueous crystalline penicillin G, 50 000 U/kg, IV, every 12 h (1 wk or younger), then every 8 h for infants older than 1 wk, for a total of 10 days of therapya (preferred)
OR - Penicillin G procaine, 50 000 U/kg, IM, as single
daily dose for 10 days
OR - Penicillin G benzathine, 50 000 U/kg, IM, single dose (recommended by some experts, but only if all components of the evaluation are obtained and are normalc and follow-up is certain)
|
Congenital syphilis
less likely | - Normal infant examination
AND - A serum quantitative nontreponemal serologic titer less than fourfold the birthing parent’s titer at delivery (eg, maternal titer = 1:8, neonatal titer ≤1:16)
AND - Birthing parent was treated during pregnancy, treatment was appropriate for stage of infection, and treatment was administered >=30 days before delivery
AND - Birthing parent has no evidence of reinfection or relapse
| | - Penicillin G benzathine, 50 000 U/kg, IM, single dose (preferred)
- Alternatively, infants whose birthing parent’s nontreponemal titers decreased at least fourfold after appropriate therapy for early syphilis or remained stable at low titer (eg, VDRL ≤1:2; RPR ≤1:4) may be followed every 2–3 mo without treatment until the nontreponemal test becomes nonreactive
- Nontreponemal antibody titers should decrease by 3 mo of age and should be nonreactive by 6 mo of age; patients with increasing titers or with persistent stable titers 6–12 mo after initial treatment should be reevaluated, including a CSF examination, and treated with a 10-day course of parenteral penicillin G, even if they were treated previously
|
Congenital syphilis is unlikely | - Normal infant examination
AND - A serum quantitative nontreponemal serologic titer less than fourfold the birthing parent’s titer at delivery
AND - Birthing parent was treated adequately before pregnancy
AND - Birthing parent nontreponemal serologic titer remained low and stable (ie, serofast) before and during pregnancy and at delivery (eg, VDRL ≤1:2; RPR ≤1:4)
| | - None, but infants with reactive nontreponemal
tests should be followed serologically to ensure test result returns to negative - Penicillin G benzathine, 50 000 U/kg, IM, single dose can be considered if follow-up is uncertain and infant has a reactive test (some experts)
- Neonates with a negative nontreponemal test result at birth and whose birthing parent was seroreactive at delivery should be retested at
3 mo to rule out incubating congenital syphilis
|
