Congenital Syphilis19

The decision to treat an infant should be based on a diagnosis of syphilis in the mother and confirmation of adequacy of maternal treatment. Clinical, laboratory, or radiographic evidence of syphilis in the infant should be documented. Maternal nontre-ponemal titers (at delivery) should be compared with the infant's nontreponemal titers. Since diagnosis based on neonatal serologic testing is complicated by the transplacental transfer of maternal IgG antibodies, which can cause a positive test in the absence of infection, neonatal titers are assessed. A titer greater than four times the maternal titer would not generally result from passive transfer and diagnosis is considered confirmed or highly probable.

The following regimens are recommended for treatment of maternal syphilis: benzathine penicillin G 2.4 million units or 7.2 million units intramuscularly over 3 weeks if the duration of syphilis has been at least a year. An alternative regimen is procaine penicillin 0.6 to 0.9 million units intramuscularly for 10 to 14 days, or ceftriaxone 1 g daily intramuscularly or IV for 8 to 10 days.

In women who experience uterine cramping, pelvic pain, or fever, administer acetaminophen to combat these symptoms. Additionally, the patient should be well hydrated and rested.

Treatment of asymptomatic neonates is with 50,000 units/kg of benzathine penicillin G in a single intramuscular dose. Symptomatic neonates should receive 50,000 units/kg of aqueous crystalline penicillin G every 12 hours intramuscularly for the first 7 days of life, then every 8 hours for 3 days, OR procaine penicillin G 50,000 IU/ kg intramuscularly as a single dose daily for 10 days.

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