Congenital syphilis in a neonate born to an adequately treated mother
The burden of syphilis has increased significantly in the United States, mirrored by a spike in rates of congenital syphilis. Treatment inadequacies exist and may be due to complexity of disease staging. This report describes a case of congenital syphilis in a neonate whose mother appeared to have been adequately treated; it also provides support for the necessity of accurate staging of disease at the time of treatment.
A 39-year-old gravida 8 para 7 presented to the office for an initial prenatal visit in her third trimester. She had a history of secondary syphilis treated with a single-dose penicillin regimen 18 months prior to her initial prenatal visit. At that time, her initial RPR titer was 256. She did not follow up with the health department for serial titers but was noted to have a greater than four-fold decline (RPR titer of 32) at her initial prenatal visit with our clinic. Based on this and her asymptomatic status, adequate treatment was presumed.
Despite adequate treatment, the patient subsequently delivered an infant with congenital syphilis. Her staging was unclear – reinfection by new partner versus late latent syphilis versus serofast state. Standard of care treatment calls for a single-dose of penicillin, but a three-dose regime has been shown to decrease the rate of treatment failure. In a woman of reproductive age in danger of being lost to follow-up, the risk of perinatal mortality may outweigh any concerns regarding antibiotic resistance and justify a more aggressive treatment regime.
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