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The Pediatric Forum |

Congenital Syphilis in Newborn Infants

Sarah A. Rawstron, MB BS; Kenneth Bromberg, MD
Arch Pediatr Adolesc Med. 1998;152(10):1041-1042. doi:.
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Although the recent article by Moyer et al1 contains interesting, informative, and thought-provoking material, we would like to make a few remarks about some issues that were not discussed.

  1. There is a typographical error in the table on page 356. The number of infants evaluated should be 853, not 833 as printed; otherwise, the numbers do not add up.

  2. Radiographic examination is not the only routine method used for screening for congenital syphilis. Lumbar punctures are also recommended for screening, yet only one patient's results were mentioned in the article. The literature suggests that findings from the radiographic examinations will be abnormal in only 70% to 80% of affected infants. The authors' own data (17 [65%] of 26 infants with congenital syphilis with abnormal radiographic findings) is in line with this percentage. Therefore, if radiographic examination is the only screening method used for congenital syphilis, then 20% to 30% of infants with congenital syphilis will be missed. Why were there no data on lumbar punctures?

  3. Since no other tests for congenital syphilis were performed in this study, and no follow-up data are given, the true number of infants with congenital syphilis cannot be inferred. It was almost certainly larger than the number given in this study.

  4. We disagree that radiographs should be eliminated from routine screening for congenital syphilis in those infants already receiving a full course of treatment. It is important for both the pediatrician and the parents to know if the child is really infected with Treponema pallidum or is only being treated because of the possibility of infection. The Centers for Disease Control and Prevention's recommendations were formulated to recommend treatment of a larger number of infants than those who actually had the disease to avoid sending infants home untreated if their condition was missed due to inaccurate diagnoses. Why does the obligation to treat remove the need for an accurate diagnosis?

  5. Staff sometimes also complain about performing lumbar punctures in infants who require treatment regardless of the cerebrospinal fluid test result. Yet a reactive cerebrospinal fluid VDRL test has important implications for infants and requires additional follow-up, including additional lumbar punctures.

  6. If the evaluation for congenital syphilis is not complete at birth, interpretation of a reactive fluorescent treponemal antibody absorption test in an older child may be difficult. Congenital syphilis may result in a reactive fluorescent treponemal antibody absorption test, but so can syphilis acquired from sexual abuse. If the child was not adequately evaluated in the neonatal period, the finding of a reactive fluorescent treponemal antibody absorption test at a later date may require reevaluation and treatment if the history is unclear (a situation we have encountered).

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