following : living in a high syphilis rate community ; history of substance use disorder ; acquisition of a sexually transmitted infection during pregnancy ; multiple sexual partners or new sex partner ; having sex in conjunction with drug use or transactional sex ; methamphetamine or heroin use ; and maternal or partner incarceration .
Parenteral penicillin is the drug of choice for the treatment of congenital syphilis . 15 Benzathine preparation is necessary as it has better CNS efficacy and aqueous humor penetration compared to other formulations . 15 Penicillin G benzathine ( 50,000 units / kg intramuscularly ) is given in a single dose regimen in infants less than 1 month of age . Children who are diagnosed after 1 month of age should be treated with intravenous aqueous penicillin G ( 50,000 units / kg every four to six hours for 10 days ). 15
Our patient received appropriate penicillin G therapy and was asymptomatic at discharge . At his one year follow up visit , he was meeting all his developmental milestones with weight and length at the 60th percentile .
CONCLUSION
Syphilis is a re-emerging disease with potentially devastating sequelae if untreated in all ages , including infancy . Thus , the CDC has recommended all pregnant patients be screened at the first visit , with repeated screenings throughout pregnancy for individuals at high risk . This case illustrates these recommendations and reviews the clinical presentation and treatment as well as the subtlety in making the diagnosis . Our case is a reminder that clinicians must suspect syphilis , even in infants , when relevant symptomatology is present .
REFERENCES
1 . Sexually Transmitted Disease Surveillance 2020 . Accessed April 12 , 2022 , https :// www . cdc . gov / std / statistics / 2020 / overview . htm #:~: text = The % 20national % 20 congenital % 20syphilis % 20 rate , 254 % 25 % 20increase % 20 relative % 20to % 202016
2 . Kidd SE , Grey JA , Torrone EA , Weinstock HS . Increased Methamphetamine , Injection Drug , and Heroin Use Among Women and Heterosexual Men with Primary and Secondary Syphilis - United States , 2013-2017 . MMWR Morb Mortal Wkly Rep . Feb 15 2019 ; 68 ( 6 ): 144-148 . doi : 10.15585 / mmwr . mm6806a4
3 . Zenker PN , Berman SM . Congenital syphilis : trends and recommendations for evaluation and management . Pediatr Infect Dis J . Jul 1991 ; 10 ( 7 ): 516-22 .
4 . Woods CR . Syphilis in children : congenital and acquired . Semin Pediatr Infect Dis . Oct 2005 ; 16 ( 4 ): 245-57 . doi : 10.1053 / j . spid . 2005.06.005
5 . Qureshi F , Jacques SM , Reyes MP . Placental histopathology in syphilis . Hum Pathol . Jul 1993 ; 24 ( 7 ): 779-84 . doi : 10.1016 / 0046-8177 ( 93 ) 90016-a
6 . Herremans T , Kortbeek L , Notermans DW . A review of diagnostic tests for congenital syphilis in newborns . Eur J Clin Microbiol Infect Dis . May 2010 ; 29 ( 5 ): 495-501 . doi : 10.1007 / s10096-010-0900-8
7 . Woods CR . Syphilis in children : congenital and acquired . Semin Pediatr Infect Dis . Oct 2005 ; 16 ( 4 ): 245-57 . doi : 10.1053 / j . spid . 2005.06.005
8 . Moyer VA , Schneider V , Yetman R , Garcia-Prats J , Parks D , Cooper T . Contribution of long-bone radiographs to the management of congenital syphilis in the newborn infant . Arch Pediatr Adolesc Med . Apr 1998 ; 152 ( 4 ): 353-7 . doi : 10.1001 / archpedi . 152.4.353
9 . Brion LP , Manuli M , Rai B , Kresch MJ , Pavlov H , Glaser J . Long-bone radiographic abnormalities as a sign of active congenital syphilis in asymptomatic newborns . Pediatrics . Nov 1991 ; 88 ( 5 ): 1037-40 .
10 . Kocher MS , Caniza M . Parrot pseudoparalysis of the upper extremities . A case report . J Bone Joint Surg Am . Feb 1996 ; 78 ( 2 ): 284-7 . doi : 10.2106 / 00004623- 199602000-00018
11 . Goraya JS , Trehan A , Marwaha RK . Wimberger ' s sign . Indian Pediatr . Dec 1997 ; 34 ( 12 ): 1133-4 .
12 . Fiumara NJ , Lessell S . Manifestations of late congenital syphilis . An analysis of 271 patients . Arch Dermatol . Jul 1970 ; 102 ( 1 ): 78-83 .
13 . Cheng JQ , Zhou H , Hong FC , et al . Syphilis screening and intervention in 500,000 pregnant women in Shenzhen , the People ' s Republic of China . Sex Transm Infect . Aug 2007 ; 83 ( 5 ): 347-50 . doi : 10.1136 / sti . 2006.023655
14 . Workowski KA , Bachmann LH , Chan PA , et al . Sexually Transmitted Infections Treatment Guidelines , 2021 . MMWR Recomm Rep . Jul 23 2021 ; 70 ( 4 ): 1-187 . doi : 10.15585 / mmwr . rr7004a1
15 . Workowski KA , Bolan GA , Centers for Disease C , Prevention . Sexually transmitted diseases treatment guidelines , 2015 . MMWR Recomm Rep . Jun 5 2015 ; 64 ( RR-03 ): 1-137 .
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