Congenital Syphilis Diagnosed Beyond the Neonatal Period in the United States: 2014–2018

Abstract

BACKGROUND AND OBJECTIVES During 2014–2018, reported congenital syphilis (CS) cases in the United States increased 183%, from 462 to 1306 cases. We reviewed infants diagnosed with CS beyond the neonatal period (>28 days) during this time. METHODS We reviewed surveillance case report data for infants with CS delivered during 2014–2018 and identified those diagnosed beyond the neonatal period with reported signs or symptoms. We describe these infants and identify possible missed opportunities for earlier diagnoses. RESULTS Of the 3834 reported cases of CS delivered during 2014–2018, we identified 67 symptomatic infants diagnosed beyond the neonatal period. Among those with reported findings, 67% had physical examination findings of CS, 69% had abnormal long-bone radiographs consistent with CS, and 36% had reactive syphilis testing in the cerebrospinal fluid. The median serum nontreponemal titer was 1:256 (range: 1:1–1:2048). The median age at diagnosis was 67 days (range: 29–249 days). Among the 66 mothers included, 83% had prenatal care, 26% had a syphilis diagnosis during pregnancy or at delivery, and 42% were not diagnosed with syphilis until after delivery. Additionally, 24% had an initial negative test result and seroconverted during pregnancy. CONCLUSIONS Infants with CS continue to be undiagnosed at birth and present with symptoms after age 1 month. Pediatric providers can diagnose and treat infants with CS early by following guidelines, reviewing maternal records and confirming maternal syphilis status, advocating for maternal testing at delivery, and considering the diagnosis of CS, regardless of maternal history.

Substance Use Among Persons with Syphilis During Pregnancy — Arizona and Georgia, 2018–2021

“…Fourth, because treatment is highly effective, the finding of 20% of persons with adequate treatment among those with congenital syphilis outcome could be an artifact of the CSTE case definition, which includes nonspecific clinical findings for probable cases or could be related to occult or undiagnosed reinfection that could not be assessed. Finally, there is no age limit for diagnosing congenital syphilis, which might create some misclassification in these data; however, almost all congenital syphilis cases are diagnosed during the neonatal period ( 10 ).…”

Secondary syphilis in a 14-month-old girl and child-to-mother transmission

“…Syphilis in early childhood, even beyond the neonatal period, is commonly associated with congenital transmission [5] .…”

Estimation of the Lifetime Quality-Adjusted Life Years (QALYs) Lost Due to Syphilis Acquired in the United States in 2018

“…Among infants who are live-born with signs and symptoms of congenital syphilis, 27% have low birth weight, and the rest have other symptoms such as condyloma lata, snuffles, syphilitic rash, and hepatosplenomegaly [ 25 ]. In the model, live-born infants with and without signs and symptoms of disease are treated with penicillin for the first 10 days of life and do not incur a long-term reduction in quality of life [ 28 , 29 ]. We assumed live-born symptomatic babies would experience symptoms for one month, whereas live-born asymptomatic babies would not have any reductions in quality of life [ 26 ].…”