Case Description: Case 1 - Ex-36-week infant female born to a 27 year old HIV negative female with no prenatal care and latent syphilis of unknown duration (RPR 1:4, TPPA+ at delivery), treated with 1 dose benzathine penicillin G (BPG) 2.4 million units (MU) IM administered 13 days post-delivery, then lost to follow-up. Infant exam normal; RPR 1:2, TPPA+; CSF with normal cell count and protein, VDRL nonreactive; classified as probable congenital syphilis. Case 2 - Ex-38-week infant male born to a 20 year old HIV negative female with late prenatal care and early latent syphilis (maternal RPR 1:16, TPPA+ at 28 weeks of pregnancy), treated with multiple BPG doses. Infant exam normal; RPR 1:64, TPPA+; CSF VDRL reactive, WBC 34, RBC 15,000, protein 152; classified as probable congenital neurosyphilis. Case 3 - Ex-37-week infant male born to an 18 year old HIV negative female with good prenatal care, maternal RPR nonreactive at 8 weeks of pregnancy. Presented to pediatrician at 11 weeks of age with nasal congestion, rash on trunk and extremities, irritability, fever, splenomegaly, scalp lesions with surrounding alopecia, and palatal ulceration. RPR 1:512, TPPA+; CSF VDRL 1:4, WBC 11, RBC 0, protein 96; long bone radiographs suspicious for syphilitic involvement of tibias bilaterally. Infant classified as probable congenital syphilis with neurologic involvement.
Discussion: Cases epidemiologically classified as “probable congenital syphilis” encompass a wide spectrum of clinical presentations, with different prenatal exposure circumstances and levels of evidence for infection. Investigation and follow-up involved traditional case and contact investigation, as well as recommendations for occupational exposure in the case of the infant with snuffles and rash.