My referral states that the child tested positive for syphilis at birth?  What further questions should I ask – can I still consider this referral?”

A diagnosis of congenital syphilis is very difficult to establish because clinical signs of infection may not be apparent and many times the blood tests are unreliable. Syphilis is a sexually transmitted disease that is transmitted from the mother to the infant via the placenta during pregnancy. Fortunately, if this infectious disease is discovered during the maternal prenatal visits it can be easily treated with Penicillin and this can preveny illness in the infant. Untreated maternal infection in the early stages of the pregnancy can lead to significant fetal morbidity whereas infection in the later part of the pregnancy can produce an asymptomatic infant.

The two most commonly used screening tests for syphilis are
(1) VDRL: is useful for screening and follow-up of known cases and
(2) RPR: used for screening.

All screening tested need to be confirmed with a more specific test called the FTA-ABS that can verify current or past infection. If this test is positive then the likelihood of having the infection is pretty good and needs to be treated.

The causes for the false positive results on the initial screening test can be secondary other medical conditions such as: (aging, pregnancy, mononucleosis, hepatitis, IV drug addiction, and some autoimmune disorder like lupus). Another reason for a false positive screening test or (VDRL or RPR) is that it may represent passively transferred antibody from the mother to the baby without actual congenital infection. In cases where positive test result  are believed  to result from passive maternal transfer in the absence of active infection, it is required to follow-up with serial measurements of VDRL, these results should normalize after  a couple of weeks.

Like in adults this infectious disease is easily treatable with injectable penicillin.
Infants with a positive confirmatory serology for syphilis should be evaluated fully.
A complete history of the maternal disease and therapy is mandatory. The infant needs to have a complete blood count done, liver function test; long bone x-rays, spinal fluid examinations.

Treatment needs to be given to infants with:

  1. Whose mother’s were inadequately treated?
  2. Mother’s who received treatment less than one month prior to delivery.
  3. Mother’s who were given medications other than penicillin.
  4. Mother’s who had undocumented or a poor blood testing response to treatment.

If the mother had received adequate therapy and there are no clinical or laboratory signs present, this infant may be followed without therapy but needs to have serial monthly blood tests performed.  Rising titers or clinical signs usually develop by 4 months in infected infants.
Infants with proved or suspected congenital syphilis require treatment with injectable penicillin every 6- 8 hours for 14 days.

Clinical signs:

usually symptomatic but when signs do develop after a few weeks they can be, Jaundice (yellowing of the skin), anemia (low blood levels), large liver and edema or swelling. Some may even have severe signs of meningitis or infection of the spinal fluid.

Young Infants: normal for first few weeks and then develop skin lesions, and a paralysis of the arms or legs. There is usually an enlarged liver or spleen, and like the newborns there is anemia. “Snuffles” (rhinitis or continuous runny nose) with a thick mucous drainage that excoriates the upper lip is found sometimes. A syphilitic rash usually occurs on the palms and feet but may occur anywhere on the body. They look like bright red spots that gradually fade.

Untreated Syphilis in the young infant may lead to stigmatas recognizable in later childhood

  1. Rhagades: scars around the mouth and nose
  2. Depressed nasal bridge (saddle nose)
  3. Permanent upper teeth peg shaped with a central notch (Hutchinson teeth)
  4. High forehead secondary to low grade meningitis

Children: (untreated with spinal fluid meningitis complications)

  1. Eye problems and infections
  2. Deafness, mental retardation
  3. Speech defects
  4. Bone manifestations


  1. Severe disease if undiagnosed may be fatal to a newborn.
  2. Complete cure can be obtained if young infant is given Penicillin
  3. Treatment of primary syphilis with penicillin is curative
  4. Blood test reversal occurs within one year
  5. Permanent neurological sequelae occur only with severe spinal disease.

Questions that you need to ask?

  1. What test were performed and at what ages? Where they repeated or confirmed?
  2. Was the mother treated during the pregnancy with penicillin?
  3. Was the infant treated with penicillin and for how long? Was it injectable?
  4. What if any follow-up testing was performed?

By: George Rogu M.D. CPE Founder of &
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