Search

Due to uncertainties about the treatment of their mothers' syphilis infections, in three neonates congenital syphilis was suspected. The mother of the first newborn, a girl, had treated herself for a syphilis infection. The second mother, who gave birth to a son, was treated adequately for her infection, but there was no record of this available at the time of birth. The third mother, who gave birth to a girl, had also been treated for syphilis, but within the month before delivery. None of the neonates had any clinical manifestations of congenital syphilis. These obscurities resulted in serological examination of all three neonates and in treatment in the first and third cases. The reported increase in the incidence of syphilis infections in The Netherlands poses a risk of more cases of congenital syphilis infection in newborns. It is crucial to be aware of the consequences of syphilis infection in the neonate and fetus, and also of the various measures available for its prevention and treatment. In The Netherlands, screening for syphilis is routinely carried out during pregnancy. If a pregnant woman is found to be infected, the therapy of choice is penicillin. The Treponema pallidum agglutination test (TPA) and the venereal disease research laboratory (VDRL) test should be performed on the mother and the newborn after birth. All infants born to seropositive but insufficiently treated mothers require careful physical examinations. Infants with proven infection or with a high index of suspicion should be treated with aqueous crystalline penicillin G for a total of 10 days. After discharge, all infants should be followed up with physical and serological examinations up to the first year of life.

Two infants, a two-month-old boy and a two-month-old girl adopted from Sri Lanka, were diagnosed as having congenital syphilis and treated accordingly. The girl presented with only skin symptoms and a developing pseudoparalysis of Parrot. The boy was in quite a bad condition, having rhinitis, an oedematous appearance, skin symptoms, severe anaemia and hepatosplenomegaly. In both patients serological blood tests and cerebrospinal fluid tests for lues were positive. Both children showed osteochondritis and periostitis of the long bones on X-rays. This disease is rare in the Netherlands, but it is important to diagnose it early, because early adequate treatment may result in complete cure.

Despite good prevention, congenital syphilis still occurs: the incidence in 1981-1986 was 9 in six years. In this case history an infant with osteomyelitis, due to congenital syphilis, is discussed. This article also gives a review of symptoms, diagnosis, therapy and follow-up after treatment. The best method for diagnosis is the 19S-IgM-FTA-absorption test in serum. Treatment concerns the pediatrician, as well as the orthopaedic surgeon, the neurologist, the dermatologist and the ophthalmologist, cooperating as an interdisciplinary team.