See also general discussion of "Syphilis"
I. Clinical features
- 40% of pregnancies in women with untreated early syphilis end in perinatal death
- Dx is HARD: 50% of liveborncases have no signs at birth; often have to make presumptive diagnosis
- "Classic signs"
- Condylomata lata
- Edema (nephrotic sd)
- Psuedoparalysis (?)
- Generalized lymphadenopathy
- Bone changes (periostitis); "Weinberger's sign" (medial tibial destruction)
II. Laboratory diagnosis
- Dark-field/direct immunofluorescence on tissue samples, e.g. umbilicus
- False neg. serol. tests may be due to 3rd-trimester inf. so mom didn't make Ab's yet, or "Prozone phenomenon" (too much Ab so false neg.)
- Note: don't screen with cord blood: Wharton's jelly can give false-pos. RPR ?
- Long bone x-ray (see 10 above)
- As of 1992, CFC guidelines were to treat all as if had neurosyphilis
- PCN 50kU/kd/dose IV Q8h x 10-14d
- Benzathine PCN? Unclear as of 1992 if can use in infants