Category | Definition | Additional evaluation to perform | Treatment | Follow-up testing (applies to all categories) |
Proven or highly probable |
Plus |
| 10 days of IV penicillin G |
|
Possible | ALL of the following:
| We further classify newborns in the "possible" category as higher or lower risk:
| ||
Higher risk:
| Higher risk:
| |||
Lower risk:
| Lower risk:
| |||
Less likely | ALL of the following:
| Not required | Single dose of IM penicillin benzathine¥ | |
Unlikely | ALL of the following:
| Not required | Not required‡ |
VDRL: venereal disease research laboratory; RPR: rapid plasma regain; DFA: direct fluorescent antibody; PCR: polymerase chain reaction; LP: lumbar puncture; CBC: complete blood count; LFTs: liver function tests; ABR: auditory brainstem response; CDC: Centers for Disease Control and Prevention; CSF: cerebrospinal fluid; IM: intramuscular; IV: intravenous.
* Findings of congenital syphilis may include hepatosplenomegaly, rash, condyloma lata, snuffles, jaundice (nonviral hepatitis), pseudoparalysis, pallor (anemia), or edema (nephrotic syndrome and/or malnutrition). Refer to UpToDate topic on congenital syphilis for additional details.
¶ A 4-fold titer is equivalent to two dilutions (eg, newborn's titer 1:32 if maternal titer is 1:8).
Δ These tests are not available in many clinical settings.
◊ Adequate treatment is defined as completion of a penicillin-based regimen, in accordance with CDC treatment guidelines, appropriate for stage of infection and initiated ≥4 weeks before delivery. Relapse or reinfection after treatment is suggested by a 4-fold increase of maternal VDRL or RPR titers after treatment. Inadequate/suboptimal therapy includes any of the following:§ The CDC guidelines include a caveat that additional evaluation may not be necessary for neonates in the "possible" category if a 10-day treatment course is planned. Nevertheless, we suggest performing the evaluation in higher-risk neonates (as defined above) since the evaluation may inform decisions regarding treatment and follow-up.
¥ Some specialists opt not to treat infants in this category and instead provide close (ie, monthly) serologic follow-up. If this approach is chosen, treatment should be provided if the infant's titers do not decline as expected over the first few months after birth.
‡ If follow-up is uncertain, some specialists would provide a single dose of IM benzathine penicillin to protect the infant in the unlikely event that the mother was reinfected.Do you want to add Medilib to your home screen?