Congenital syphilis: How long do we have to deal?
Congenital syphilis is a preventable disease and its presence reflects a failure of prenatal care delivery system, as well as syphilis control programs. Adequate antenatal screening is a boon to prevent cases of congenital syphilis. There have been sporadic case reports of congenital syphilis in our country, but the exact disease burden is not very clear.

The present case has been published in the Indian Journal of Child Health. A male neonate born to a G3P1A1L1 mother by full-term normal vaginal delivery. He was born to a non-consanguineous parents, with a birth weight of 3.8 kg.. Mother had an uneventful pregnancy, however, found to be venereal disease research laboratory (VDRL) positive. During her first pregnancy, mother was VDRL positive, the female baby was born, who was asymptomatic and VDRL negative at the time of birth and continued the same status till date.

During the second pregnancy, the outcome was abortion. This time during the third pregnancy; VDRL was positive, but quantitative titers were not available. She was treated with Inj. benzathine penicillin before this pregnancy but repeat VDRL titer post-treatment was not available. No treatment was taken during the pregnancy.The baby cried immediately after birth. On examination, vitals were stable; cry, tone, and activity were normal and no markers of syphilis were found on the clinical examination.

The baby was taking breastfeeds normally and passing urine and stools adequately. On laboratory investigation, serum VDRL was reactive (1:256), T. pallidum hemagglutination assay (TPHA) was detected (1:160), and cerebrospinal fluid (CSF) VDRL was also reactive. After delivery, maternal VDRL was reactive (1:32) and TPHA was detected (1:1280). There was a 4-fold rise in neonatal VDRL titers.

Other investigations in the neonate revealed normal hemogram, negative sepsis screen, normal liver, and renal function tests and negative results for hepatitis B surface antigen, anti-hepatitis C virus, and human immunodeficiency virus.

Radiological investigations were normal with normal ultrasonography abdomen. Diagnosis of congenital neurosyphilis was made based on positive serological tests. Neonate was managed with intravenous sodium benzylpenicillin G-50,000 U/kg/dose twice daily for 7 days, then thrice daily for next 3 days and supportive therapy.

During follow-up, the patient was asymptomatic, and CSF and serum VDRL were non-reactive after 6 months. Later, the mother was treated with Inj. benzathine penicillin as per guidelines and VDRL became non-reactive.

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