See also general discussion of "Syphilis"

I. Clinical features

  1. 40% of pregnancies in women with untreated early syphilis end in perinatal death
  2. Dx is HARD: 50% of liveborncases have no signs at birth; often have to make presumptive diagnosis
  3. "Classic signs"
  1. "Snuffles"
  2. Rash
  3. HSM
  4. Jaundice
  5. Condylomata lata
  6. Meningitis
  7. Edema (nephrotic sd)
  8. Psuedoparalysis (?)
  9. Generalized lymphadenopathy
  10. Bone changes (periostitis); "Weinberger's sign" (medial tibial destruction)

II. Laboratory diagnosis

  1. Dark-field/direct immunofluorescence on tissue samples, e.g. umbilicus
  2. 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.)
  3. Note: don't screen with cord blood: Wharton's jelly can give false-pos. RPR ?
  4. Long bone x-ray (see 10 above)

III. Treatment

  1. As of 1992, CFC guidelines were to treat all as if had neurosyphilis
  2. PCN 50kU/kd/dose IV Q8h x 10-14d
  3. Benzathine PCN? Unclear as of 1992 if can use in infants