Congenital syphilis. Serologic diagnosis in the young infant

Abstract

The diagnosis of congenital syphilis in the newborn or young infant must incorporate epidemiologic, clinical, and serologic evidence of infection. Anti-treponemal IgM assays such as the 19S-IgM-FTA-ABS, which can be performed at the CDC at the request of state health departments, and the IgM ELISA being developed by Ortho Diagnostics represent the most available of the new assays. Discrimination of CNS involvement by T. pallidum by new methods continues to be difficult in the absence of a "gold standard" for comparison; thus, the current recommendation is to treat all infected infants with a regimen adequate to eradicate neurosyphilis. Although tremendous progress has been made in recent years in new serologic techniques applicable to congenital syphilis, none have proved reliable enough yet to be widely used by physicians evaluating infants at risk. In conclusion, there is still no single serologic assay that will reliably diagnose congenital syphilis in the young infant and the weight of therapeutic decisions still rests on the physician's ability to synthesize epidemiological, clinical, and laboratory data.