• All women must be screened serologically for syphilis at first trimester and again at the early third trimester of pregnancy.
• Per state of Illinois, any woman who delivers a stillborn infant after 20 weeks’ gestation must be tested for syphilis. No infant should leave the hospital without the serologic status of the infant's mother having been determined at least once during pregnancy

Illinois (IL) Prenatal Syphilis Act (410 ILCS 320)

Congenital Syphilis

Congenital syphilis (CS) occurs when bacteria Treponema pallidum is transmitted from a pregnant woman to her fetus. Infection can result in stillbirth, prematurity, or a wide spectrum of clinical manifestations.

Clinical Description

Symptoms:   Please click here for a downloadable images gallery.

Early Congenital Syphilis — is arbitrarily defined by clinical manifestations with onset before two years of age. Clinical manifestations in untreated infants usually appear by three months of age, most often by five weeks.  Click here for signs of congenital syphilis.

Late Congenital Syphilis — is arbitrarily defined by clinical manifestations with onset after two years of age.  Hutchinson's triad (Hutchinson's teeth, interstitial keratitis, and eight nerve deafness) is considered pathognomonic of late congenital syphilis.  Click here for signs of late congenital syphilis. 

Laboratory Criteria for Diagnosis of Syphilis

Direct visualization with dark field microscopy rarely done and only useful for open lesions, body fluids, or neonatal nasal discharge, or;

Polymerase chain reaction (PCR) or other equivalent direct molecular methods of lesions, neonatal nasal discharge, placenta, umbilical cord, or autopsy material, or;

Immunohistochemistry (IHC), or special stains (e.g., silver staining) of specimens from lesions, placenta, umbilical cord, or autopsy material or;

Serological Tests:

Recommended Regimens for Neonates (Infants Aged <30 Days)

Detailed treatment recommendations can be found at CDC 2015 STD Treatment Guidelines.

Follow-Up for Neonates (Infants Aged <30 Days)

All neonates with reactive non-treponemal tests should receive careful follow-up examinations and serologic testing (i.e., a non-treponemal test) every 2–3 months until the test becomes nonreactive.  Click here for details.

Evaluation and Treatment of Infants and Children with Congenital Syphilis (Infants and children aged ≥1 month)

Special Considerations

Penicillin Allergy

Infants and children who require treatment for congenital syphilis but who have a history of penicillin allergy or develop an allergic reaction presumed secondary to penicillin should be desensitized and then treated with penicillin.  (2015 CDC STD Guidelines, Management of Persons Who Have a History of Penicillin Allergy p. 49).

Penicillin Shortage

During periods when the availability of aqueous crystalline penicillin G is compromised, the following is recommended (2015 CDC STD Guidelines, Penicillin Shortage p. 47).

HIV Infection

Infants and children at risk for congenital syphilis should receive a full evaluation and testing for HIV infection. Please note that evidence is insufficient to determine whether infants and children who have congenital syphilis and HIV require different therapy or clinical management than is recommended for all infants and children. All infants and children with congenital syphilis and HIV infection should be managed like infants and children without HIV infection.