GuidelinesOther guideline
Management of Congenital Syphilis
Management guidelines for students, interns and registrars on a variety of routine and emergency situations in our neonatal service at Tygerberg Children’s Hospital. Published in 2014.
Signs of probable congenital syphilis (single sign is suggestive):
Signs of possible congenital syphilis in asymptomatic infants (two or more signs are suggestive):
Follow-up for fully treated congenital syphilis
(If mother's RPR status is unknown, please test mother)
| MOTHER'S RPR STATUS | ||
| Reactive | Non-reactive | |
| Infant with signs of congenital syphilis (1 probably sign/2 possible signs) | * Pen G 50 000 U/kg/dose IVI bd for the first 7 days of life thereafter 8hrly till the 10th day OR * Procaine Pen 50 000 U/kg daily IMI for 10 days | Repeat test on mother and baby |
| Infant without signs of congenital syphilis | Bicillin 50 000/U/kg stat IMI | No treatment |
Signs of probable congenital syphilis (single sign is suggestive):
- skin rash, (palmar and plantar)
- hepatosplenomegaly,
- pseudoparalysis,
- hydrops,
- ascites,
- nasal discharge/snuffles
Signs of possible congenital syphilis in asymptomatic infants (two or more signs are suggestive):
- Low birth weight,
- fever,
- conjugated and prolonged jaundice,
- anaemia at birth
- petechiae / purpura,
- syphilitic facies
Exception to the rule
- HIV positive mother who is RPR reactive and untreated for syphilis when an asymptomatic baby:
- If clinician is uncertain
Perform RPR titre in baby:
- If RPR titre is ≥ 4 times the mother - 10 days of Penicillin*
- If RPR titre is <4 times the mother - Bicillin 50 000U/kg stat IMI
Follow-up for fully treated congenital syphilis
- Ensure maternal partner is treated
- Neonates treated for congenital syphilis to be notified
- 3-month follow up visits at C3A (clinic) with repeat RPR-titre (for 1 year) until results become non-reactive or the tire has decreased four-fold (if not: to discuss re-treatment with infectious disease consultant).