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Clinical Features and Follow-up of Congenital Syphilis

Lago, Eleonor G. MD, PhD; Vaccari, Alessandra MSc; Fiori, Renato M. MD, PhD

doi: 10.1097/OLQ.0b013e31827bd688
Original Study

Objective: The aim of this study was to investigate clinical features and outcomes of children treated for congenital syphilis (CS).

Methods: Infants born alive in the public sector of São Lucas Hospital, Porto Alegre, Brazil, 1997 to 2004, whose mothers had syphilis and neonates with CS born in other facilities and admitted during this period were included. Follow-up was performed from birth up to 5 years.

Results: Among 24,920 live births, 379 (1.5%) met the criteria for CS. A further 19 infants born in other hospitals were included, for a total of 398 with CS. We compared infants with CS with 120 infants whose mothers received adequate treatment of syphilis before delivery (total sample, 518 infants). Congenital syphilis was associated with delivery before 34 weeks, low birth weight, and small for gestational age. During the study period, 37 stillbirths with CS were detected. Result from the serum venereal disease research laboratory test was negative at birth in 17.5% of the neonates with CS, and in 4 infants, it became positive after the second day. Thirty percent of the infants with CS were reevaluated between 8 and 60 months, and most had a good outcome when managed according to standard guidelines. Sixteen infants (13.3%) had sequelae. Of these, 8 were symptomatic in the neonatal period, and 13 (81%) of 16 had laboratory/x-ray findings. All asymptomatic and 78% of symptomatic infants had nonreactive fluorescent treponemal antibody absorption test after 12 months of age.

Conclusions: Congenital syphilis remains an impacting disease that causes fetal and neonatal deaths, prematurity, low birth weight, and severe and irreversible sequelae in some children. This study confirms the value of standard guidelines for its management.

A follow-up study compared 398 infants with congenital syphilis with 120 whose mothers were adequately treated before delivery.

From the Department of Pediatrics, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil

The authors thank Denise Marafon, Denise Rovinski, Guilherme D. Pinheiro, Guilherme Guaragna Filho, Jaqueline Pompeo, Marilia C. Brust, and Vanessa C. de Azevedo for their contributions to data collection and entry.

Supported by a grant (No. 474985/01-6) from the Brazilian National Council of Scientific and Technological Development (CNPq).

Alessandra Vaccari was a fellow of the Brazilian Coordination for Improvement of Higher Education Personnel (CAPES).

Correspondence: Eleonor G. Lago, MD, PhD, Department of Pediatrics, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Av. Ipiranga 6690, Hospital São Lucas da PUCRS, CEP 90610-000 Porto Alegre, RS, Brazil. E-mail:

Received for publication March 19, 2012, and accepted September 5, 2012.

© Copyright 2013 American Sexually Transmitted Diseases Association