Syphilis, Early Congenital

Description

Diagnostic criteria

General and supportive measures

Medicine treatment

Referral

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ICD-10 code: A50.9

*Notifiable condition

DESCRIPTION

Multi-organ infection caused by T. pallidum and acquired by vertical transmission via the transplacental route during pregnancy.

DIAGNOSTIC CRITERIA

Clinical

• Suspect if mother has syphilis or positive serology for syphilis and the baby a positive non-treponemal serological test at birth with a titre at least 4-fold higher than that of the mother.
• Large, pale, greasy placenta.
• The following signs may be present at birth or will develop within the first 3 months of life:
  • hydrops fetalis,
  • thrombocytopenia,
  • anaemia,
  • lymphadenopathy,
  • hepatosplenomegaly,
  • jaundice,
  • oedema,
  • hypoalbuminaemia,
  • condylomata,
  • pneumonia alba,
  • hepatitis,
  • meningitis,
  • nephrosis/nephritis,
  • interstitial keratitis, and
  • transient bullous lesions, commonly on the hands and feet with later desquamation and an erythematous appearance of palms and soles.
• A generalised, reddish, maculopapular rash that may desquamate.
• Rhinitis with mucopurulent bloodstained discharge excoriating the upper lip.
• Other mucocutaneous lesions of the mouth, anus and genitalia, healing with scars, especially the corners of the mouth and on the chin.
• Involvement of long bones with/without pseudoparalysis of one or more limbs and radiological findings.

Investigations:

If mother is positive for syphilis:

• X-ray of long bones:
  • translucent metaphyseal bands,
  • osteochondritis,
  • osteitits, and
  • metaphysitis and periostitis.
• Confirm syphilis with:
  • Non-treponemal serological tests, i.e. RPR, VDRL, in mother and baby.
    (Do not use umbilical cord blood at delivery for laboratory investigations.)

GENERAL AND SUPPORTIVE MEASURES

• Nurse infant in a neutral thermal environment.
• Maintain adequate nutrition and hydration.
• Monitor hepatic and renal function.
• Ensure maternal and paternal treatment if positive.

Pneumonia

To maintain oxygen saturation at 90–95% or PaO₂ at 60–80 mmHg (8 -10.5 kPa):

• Oxygen.
    1 kPa = 7.5 mmHg
    1 mmHg x 0.133 = 1 kPa

Anaemia

If anaemia is present according to thresholds in figure 1 above:

• Packed red cells, IV, 10–15 mL/kg over 3-4 hours in haemodynamically stable patients. More rapid transfusions may be appropriate in bleeding and haemodynamically unstable patients.

MEDICINE TREATMENT

Asymptomatic, well baby

Mother seropositive or result unknown, and mother has not been treated or was only partially treated:

• Benzathine benzylpenicillin (depot formulation), IM, 50 000 units/kg as a single dose into the antero-lateral thigh.

Symptomatic baby

• Procaine penicillin, IM, 50 000 units/kg daily for 10 days (not for IV use).

OR

• Benzylpenicillin (Penicillin G), IV, 50 000 units/kg 12 hourly for 10 days.

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CAUTION
Procaine penicillin and benzathine benzylpenicillin must not be given intravenously.

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Follow up children at 3 months post treatment with repeat non-treponemal serological tests, until test becomes non-reactive. Re-treat if drop in titre less than 4-fold.

Prevention

Screen pregnant women for syphilis at first visit and repeat during the second and/or third trimester. Investigate and treat both parents, if necessary.

REFERRAL

• Symptomatic infant with complications, e.g. respiratory failure, hepatic failure, nephrotic syndrome and meningitis.

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Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition

Chapter  19: Prematurity And Neonatal Conditions, 19.5 Infections, 19.5.4 Syphilis, Early Congenital