Reactive maternal nontreponemal test (RPR or VDRL)

Evaluate birthing parent’s treatment history for syphilis

False-positive reaction: no further evaluation (if pregnant, repeating with another treponemal test may be appropriate)

End

Congenital syphilis unlikely (see Table)

Possible congenital syphilis (see Table)

Proven or highly probable congenital syphilis (see Table)

Proven or highly probable congenital syphilis (see Table)

Congenital syphilis less likely (see Table)

If epidemiologic risk and clinical probability of syphilis is low, no further evaluation is required
If not low, consider repeat RPR or VDRL in 2–4 wk to differentiate early primary infection from false positive

Reactive maternal RPR/VDRL at 2–4 wk

Possible congenital syphilis (see Table)

Proven or highly probable congenital syphilis (see Table)

^a Treponema pallidum particle agglutination (TP-PA) (which is the preferred treponemal test) or fluorescent treponemal antibody absorption (FTA-ABS).

^b Test for human immunodeciency virus (HIV) antibody. Infants of HIV-infected mothers do not require different evaluation or treatment for syphilis.

^c A fourfold change in titer is the same as a change of 2 dilutions. For example, a titer of 1:64 is fourfold greater than a titer of 1:16, and a titer of 1:4 is fourfold lower than a titer of 1:16. When comparing titers, the same type of nontreponemal test should be used (eg, if the initial test was an RPR, the follow-up test should also be an RPR).

^d Stable VDRL titers 1:2 or less or RPR 1:4 or less beyond 1 year after successful treatment are considered low serofast.

^e Complete blood cell (CBC) and platelet count; cerebrospinal fluid (CSF) examination for cell count, protein, and quantitative VDRL; other tests as clinically indicated (eg, chest radiographs, long-bone radiographs, eye examination, liver function tests, neuroimaging, and auditory brainstem response). For neonates, pathologic examination of the placenta or umbilical cord with specific fluorescent antitreponemal antibody staining, if possible.