34753 Spectrum of Probable Congenital Syphilis, Massachusetts 2013

Tuesday, June 10, 2014: 7:00 AM
Dogwood B
Barbara Coughlin, RN, Division of STD Prevention, Massachusetts Department of Public Health, Boston, MA, Marla Early-Moss, BS, Division of Sexually Transmitted Disease Prevention, Massachusetts Department of Public Health, Boston, MA and Katherine Hsu, MD, MPH, Division of STD Prevention and Ratelle STD/HIV Prevention Training Center of New England, Massachusetts Department of Public Health, Jamaica Plain, MA

Introduction:  In the past decade, ≤1 case of congenital syphilis has been reported in Massachusetts annually. We report 3 Massachusetts cases from 2013 that highlight a spectrum of clinical and public health management issues.

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.