Congenital syphilis may occur if the mother has syphilis during pregnancy. If the mother has received adequate penicillin treatment during pregnancy, the risk to the infant is minimal. However, all infants should be examined carefully at birth and at frequent intervals thereafter until nontreponemal serologic tests are negative.

Infected infants are frequently asymptomatic at birth and may be seronegative if the maternal infection occurred late in gestation. Infants should be treated at birth if maternal treatment was inadequate, unknown, with drugs other than penicillin, or if adequate follow-up of the infant cannot be ensured.

Infants with congenital syphilis should have a CSF examination before treatment. Infants with abnormal CSF:

(1)

Aqueous crystalline penicillin G, 50,000 units/kg intramuscularly or intravenously daily in 2 divided doses for a minimum of 10 days. OR

(2) Aqueous procaine penicillin G, 50,000 units/kg intramuscularly daily for a minimum of 10 days. Infants with normal CSF:

Benzathine penicillin G, 50,000 units/kg intramuscularly in a single dose. Although benzathine penicillin has been previously recommended and widely used, published clinical data on its efficacy in congenital neurosyphilis are lacking. If neurosyphilis cannot be excluded, the procaine or aqueous penicillin regimens are recommended. Since cerebrospinal fluid concentrations of penicillin achieved after benzathine penicillin are minimal to nonexistent, these revised recommendations seem more conservative and appropriate until clinical data on the efficacy of benzathine penicillin can be accumulated. Other antibiotics are not recommended for neonatal congenital syphilis.

International Notes

Penicillin therapy for congenital syphilis after the heonatal period should be with the same dosages used for neonatal congenital syphilis. For larger children the total dose of penicillin need not exceed the dosage used in adult syphilis of more than 1 year's duration. After the neonatal period, the dosage of erythromycin and tetracycline for congenital syphilitics who are allergic to penicillin should be individualized but need not exceed dosages used in adult syphilis of more than 1 year's duration. Tetracycline should not be given to children less than 8 years of age.

FOLLOW-UP AND RETREATMENT

All patients with early syphilis and congenital syphilis should be encouraged to return for repeat quantitative nontreponemal tests 3, 6, and 12 months after treatment. Patients with syphilis of more than 1 year's duration should also have a repeat serologic test 24 months after treatment. Careful follow-up serologic testing is particularly important in patients treated with antibiotics other than penicillin. Examination of CSF should be planned as part of the last follow-up visit after treatment with alternative antibiotics. All patients with neurosyphilis must be carefully followed with serologic testing for at least 3 years. In addition, follow-up of these patients should include clinical reevaluation at 6-month intervals and repeat CSF examinations, particularly in patients treated with alternative antibiotics.

The possibility of reinfection should always be considered when retreating patients with early syphilis. A CSF examination should be performed before retreatment unless reinfection and a diagnosis of early syphilis can be established.

Retreatment should be considered when:

ALASKA

Anchorage: Greater Anchorage Area Borough, change name to:

Municipality of Anchorage Dept. of Health and Environmental Protection

CALIFORNIA

Fresno: County Dept of Health, change address to: P. O. Box 11867, change zip code to: 93775 (from 515 South Cedar Ave. 93702), change no fee charged to: fee charged

Napa: County Health Dept., change telephone numb 707-253-4461

FIGURE 1. Reported influenza activity, April 1, 1976, CDC telephone survey

Influenza activity continued to decline according to a CDC telephone survey conducted April 1. Three states reported no cases, and 34 states, Puerto Rico, and the District of Columbia reported isolated cases. The remaining 13 states reported regional outbreaks; widespread outbreaks ceased (Figure 1).

Pneumonia and influenza (P and I) deaths from 121 cities also continued to decrease, although mortality remained significantly above the epidemic threshold. The greatest decreases in P and I mortality were seen in the Pacific and Mountain region, while slight increases were noted in the West North Central and South Atlantic regions. Reported by Viral Diseases Div, Bur of Epidemiology, CDC.

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