Desi M.

Newberry, DNP, NNP-BC ❍ Section Editor

Special Series: Congenital Infections

1.5
HOURS

Congenital Syphilis Continuing Education

A Discussion of Epidemiology, Diagnosis, Management, and Nurses’ Role

in Early Identification and Treatment
Christine R. Rowe, MSN, RN, CCRN; Desi M. Newberry, DNP, NNP-BC; Amy J. Jnah, DNP, NNP-BC

ABSTRACT
Background:  Syphilis is caused by the spirochete bacterium Treponema pallidum. Syphilis left untreated, or inade-
quately treated during pregnancy, can result in congenital syphilis (CS). Congenital syphilis can lead to severe sequelae
Downloaded from http://journals.lww.com/advancesinneonatalcare by BhDMf5ePHKbH4TTImqenVCEuRsfpwK1Fn/L0AG/Eu/+7MopXeMA4z39f/bftPPhwywtOxrJH98o= on 09/01/2020

or fetal, neonatal, or infant death.

Purpose:  To discuss the epidemiological trends, pathophysiology, diagnosis, and management of CS; the implications
of CS upon the infant; as well as the importance of the nurse’s role in the prompt identification of CS and the timely
interventions needed to minimize sequelae.
Methods:  A literature search was completed using ProQuest, CINAHL, Google Scholar, and PubMed. Articles published
within the past 10 years were included.
Findings:  Epidemiological trends of CS in the United States indicate that maternal syphilis infection and CS are on the
rise. Risk factors include ethnicity, socioeconomic status, access to prenatal care, and sexual behaviors, as well as com-
pliance with prenatal syphilis screening by prenatal providers. Risks of CS to the developing fetus begin at approximately
14 weeks. Timely treatment is necessary to minimize or eliminate mortality and morbidity.
Implications for Practice:  Evidence-based, interprofessional strategies, which promote a collaborative perinatal/neona-
tal preventative approach to care of the pregnant female, are indicated to reverse the increasing incidence of CS within
the United States. Strategies prioritizing early identification and treatment of at-risk neonates are necessary to reduce/
eliminate the devastating long-term consequences of CS upon this vulnerable population.
Implications for Research:  The paucity of research, which focuses on CS, is most likely due to ethical concerns related
to infants as research participants and provides an opportunity for future research. Future research could focus on factors
that focus on maternal–fetal/maternal–child transmission of CS.
Key Words:  community health, congenital infections, congenital syphilis, epidemiology, management, pathophysiology,
screening, syphilis during pregnancy, treatment

S
yphilis is a sexually transmitted bacterial Ethnic disparities, low socioeconomic status,
infection. If detected early, syphilis is consid- unsafe sexual practices, inadequate treatment during
ered both treatable and curable, with little pregnancy, and partial or no prenatal care due to
risk for comorbidities. Despite proactive efforts by limited access to medical care in certain North
the World Health Organization (WHO) (2007- American regions are positively associated with an
2012) to curb the spread of syphilis, cases of primary increased risk for syphilis infection during preg-
and secondary syphilis continue to trend upward.1-3 nancy and subsequent CS.2,5,6 Furthermore, the
More specifically, rates of primary and secondary stigma and discrimination associated with sexually
syphilis infections rose from 0.9 to 1.9 cases per transmitted infections often deter at-risk females
100,000 females (2012-2016), with rates of syphilis from seeking appropriate prenatal care.2,5,6 Inconsis-
highest among females living within the Western and tent maternal syphilis screening during pregnancy
Southern regions of North American.4 Similarly, contributes to missed diagnostic and curative oppor-
rates of congenital syphilis (CS) infection rose from tunities, fetal infection, and resultant mortality and
8.4 to 15.7 cases per 100,000 live births from 2012 morbidity risks.2,5,6
to 2016, an 86.9% increase.4 Congenital syphilis impacts both perinatal and
neonatal care. Congenital syphilis can be acquired
transplacentally, as early as the 14th week of fetal
Author Affiliation: East Carolina University, Greensboro, North development, or by direct skin-to-skin contact with
Carolina. a vaginal syphilitic lesion during delivery.7 Syphilis
Work occurred at East Carolina University. left untreated during pregnancy can lead to severe
The authors declare no conflicts of interest. fetal neurological, developmental, and musculoskel-
Correspondence: Christine R. Rowe, MSN, RN, CCRN, East Carolina etal impairments, as well as fetal demise.8,9 Morbid-
University, 2314 Meadow Gate Dr, Greensboro, NC 27455 (rowech16@
students.ecu.edu; rnchrissy25@yahoo.com). ity and mortality risks during the perinatal period
Copyright © 2018 by The National Association of Neonatal Nurses are estimated at 33.6% and 6.5%, respectively.10
DOI: 10.1097/ANC.0000000000000534 Maternal syphilis infection may be without obvious

438 Advances in Neonatal Care • Vol. 18, No. 6 • pp. 438-445

Copyright © 2018 National Association of Neonatal Nurses. Unauthorized reproduction of this article is prohibited.
 Congenital Syphilis 439

clinical manifestations and hidden behind a shroud Ethnic disparities are well reported. The incidence
of shame; therefore, properly timed prenatal screen- of syphilis among African Americans is 43.1 cases
ing is crucial.11 per 100,000 live births compared with American
Increased awareness of CS is essential for the Indians with 31.6 cases per 100,000 live births.3
obtainment of optimal neonatal outcomes. The pur- Hispanics account for 20.5 cases per 100,000 live
pose for this article is to present pertinent epidemio- births, while Asian and Pacific Islanders account for
logical trends, as well as the pathophysiology, diag- 9.2 cases per 100,000 live births, and whites with
nosis, and management of CS, as it relates to 5.3 cases per 100,000 live births.4 Thoughtful con-
collaborative nursing and medical care of the sideration of ethnicity as a risk factor for CS infec-
affected family unit. tion is important.

EPIDEMIOLOGICAL TRENDS: 2007 TO MATERNAL SYPHILIS INFECTION

2016
Syphilis is caused by the spirochete bacterium Trepo-
In 2007, 12 million individuals were infected with nema pallidum and is predominately transmitted by
syphilis annually, with pregnant females accounting sexual contact with an infected lesion.9 Major risk
for 1.9 million of all cases.1,2 Due to those staggering factors for the acquisition of syphilis include sexual
statistics, the WHO launched an 8-year global initia- contact with men who are sexually active with other
tive aimed at eliminating mother-to-child transmis- men, African American ethnicity, a history of sexu-
sion of syphilis by 2015. Scheduled prenatal testing ally transmitted infections, multiple sexual partners,
in the first and third trimesters and treatment of illicit drug use, poverty, poor education, and unin-
seropositive women and their infected partners were sured or underinsured medical status.12,13 Syphilis
adopted as standards of practice, to promote early infection is divided into 4 sequential stages based
detection and timely treatment of CS.1,2 upon clinical findings: primary, secondary, latent,
The WHO initiative resulted in a temporary and tertiary.
regression in the incidence of CS. Over the past
5 years, however, failed adherence to prenatal screen- Primary Infection
ing, risky sexual behaviors, and late or limited pre- The highly contagious primary stage of syphilis occurs
natal care have contributed to the aggregate increased within the first 90 days of exposure.9,14 Clinical mani-
rates of CS infection within the United States, from festations are usually limited to one or few lesions at
8.4 to 15.7 per 100,000 live births (2012-2016) the origin of infection.14 For pregnant females, pri-
(Figure 1).4 The majority of maternal and CS infec- mary infection often occurs intravaginally, as a result
tions are observed within the Western and Southern of sexual intercourse. If detected by prenatal provid-
United States, with an alarming 42.3% increase in ers, primary infection can be treated and cured. If
cases of CS (2012-2016) in the West (Figure 2).4 undiagnosed, congenital infection is likely.9

FIGURE 1

Congenital syphilis—reported cases by year of birth and rates of primary and

secondary syphilis among women.4 CDC report showing in graph format, the
reported cases of congenital syphilis and primary and secondary syphilis among
women in the United States from 2007 to 2016. CDC materials available on the
CDC web site are in the public domain and free of copyright restrictions unless
otherwise noted.

Advances in Neonatal Care • Vol. 18, No. 6

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440 Rowe et al

FIGURE 2

Congenital syphilis—rates of reported cases among infants per 100,000 live

births.4 CDC report formatted as a map of the United States and outlying areas
illustrating the rate of reported cases of congenital syphilis per 100,000 live
births in 2016. CDC materials available on the CDC web site are in the public
domain and free of copyright restrictions unless otherwise noted.

Secondary Infection insomnia, memory loss, and personality changes.9,17

If left untreated, primary syphilis will progress to A common cardiovascular presentation is proximal
secondary syphilis. Manifestations may include aortic aneurysm with aortic regurgitation.17
maculopapular rashes on the palms of the hands and
soles of the feet, as well as sores on the genitals, PATHOPHYSIOLOGY OF CONGENITAL
anus, or mouth. Other commonly reported clinical SYPHILIS INFECTION
manifestations include fever, malaise, lymphadenop-
athy, and myalgia. These clinical findings may mimic Although CS can be acquired at any time during
other commonly occurring diseases, such as flu and pregnancy or birth, transplacental transmission
the common cold, increasing the risk for missed commonly occurs during the early fetal period of
diagnostic opportunities by primary care and prena- development (14-16 weeks of gestation), a time
tal care providers.9,15 when T. pallidum spirochetes that are transmitted
across the placenta are able to pass through the cho-
Latent Infection rionic layers of the amniotic sac and infiltrate the
Untreated secondary infection will progress to latent developing fetus.7,18 After fetal infection occurs, per-
syphilis. During the stage of latent syphilis, the infec- vasive spirochetal dissemination can affect and dis-
tion is concealed. No visible clinical manifestations rupt multiple organ systems.7 Approximately 21%
are evident.9,16 to 40% of untreated or inadequately treated mater-
nal syphilis cases result in fetal loss.2 Fetal death is
Tertiary Infection mainly caused by placental infection and the resul-
Some affected persons will develop tertiary syphilis tant decrease in placental blood flow.7 Vertical trans-
often decades after primary infection. In this case, mission occurs when the mother transmits the bacte-
the infection lies dormant (patient is seropositive but ria to the infant during birth; although less common,
asymptomatic) within the body and can present transmission is possible if the infant comes in con-
decades after the initial infection.7 The tertiary stage tact with an infected lesion when passing through
is associated with life-threatening comorbidities the birth canal.9
including multiorgan damage and failure.16 Comor-
bidities may include infiltrative tumors of the skin, Clinical Manifestations of Congenital
bones, and liver, occurring in up to 15% of all cases.7 Syphilis
Most often seen in the liver, these proliferative lesions Infants may have typical signs and symptoms or they
are believed to occur as an inflammatory response to may be asymptomatic.19 The stage of maternal syph-
the treponemes.17 Neurological complications ilis, prenatal treatment, fetal immunological
include meningovascular and parenchymatous dam- response, and gestational age influence the degree of
age and neurosyphilis, which manifests as irritability, clinical manifestations.7,9 The disease may manifest

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 Congenital Syphilis 441

in 2 categories: early congenital syphilis (ECS) and Late Congenital Syphilis

late congenital syphilis (LCS). Untreated ECS may lead to LCS, which is diagnosed
any time after 2 years of age.22 Late CS develops in
Early Congenital Syphilis approximately 40% of untreated children; symp-
ECS is usually identified by 3 months of age, but toms include syphilitic rhinitis, syphilitic vasculitis,
symptoms may present as late as 2 years of age.7,19 interstitial keratitis, and neurological and musculo-
Typical features seen in ECS include organomegaly, skeletal abnormalities.7,9 Syphilitic rhinitis can affect
jaundice, anemia, thrombocytopenia, mucocutaneous the central portion of the face, causing deformities
lesions, generalized edema, and abnormalities of the of the nose, cartilage, and maxilla.7 Syphilitic vascu-
eyes, ears, and nose.7 Hepatomegaly presents in nearly litis is responsible for dental abnormalities such as
all infants, while splenomegaly presents in approxi- peg-shaped, wide-spaced teeth known as Hutchin-
mately half of cases.7 Jaundice occurs due to direct son’s teeth; mulberry molars, which are character-
hyperbilirubinemia with elevated serum transaminase ized by hypertrophy and pitting of the enamel; and
and alkaline phosphatase concentrations as a result of increased risk of cavities.7,9 A classic finding is per-
syphilitic hepatitis and hemolytic anemia.7 The pres- foration of the hard palate.23 Interstitial keratitis is
ence of petechial lesions may be a result of thrombo- usually manifested as secondary glaucoma or cor-
cytopenia from abnormal spleen and liver functions.7 neal clouding and may not present until the second
Mucocutaneous involvement may present at birth decade of life.7
or within the first few weeks of life as small copper- Neurological involvement (neurosyphilis) can
red maculopapular lesions on the body, with the result in hydrocephalus, seizure disorders, develop-
hands and feet being the most likely and most mental delays, deafness, blindness, and juvenile gen-
severely affected areas (Figure 3).7,9,20,21 Mucocuta- eral paresis.7 Musculoskeletal manifestations are
neous lesions and the associated discharge are highly rare at this stage but may include frontal bossing, a
infectious and contain a large amount of the spiro- bulging of the forehead; saber shin, a bowing of the
chete.7 Rhinitis with bloody mucus discharge (snuf- tibia; osteochondritis and periostitis at the epiphysis
fle) may be present during the first week of life or as and metaphysis, resulting in lucent epiphyseal bands
late as 3 months of age.7,9 Ocular and vestibular (Figure 4); Higoumenakis’ sign, a unilateral enlarg-
involvement, although rare in the early stage, may ing of the clavicle; and Clutton’s joints, a bilateral
include chorioretinitis, glaucoma, uveitis, cataracts,
eyelids lesions, and hearing loss.7 Ulceration of the
nasal mucosa may spread to the nasal cartilage, FIGURE 4
causing a saddle nose deformity, or collapse of the
nasal bridge.7 Other general symptoms may include
feeding difficulties, failure to thrive, irritability,
fever, malaise, and pneumonia.15

FIGURE 3

Congenital syphilis long bone x-ray. Osteochondritis

Congenital syphilis skin rash/copper-red maculo- and periostitis resulting in lucent epiphyseal
papular lesions.7,9,20,21 Cutaneous findings can bands.24 Syphilitic changes of the skeletal system
appear at birth or within the first few weeks of life demonstrated on radiographic examination as
as desquamated copper-red maculopapular skin diaphyseal periostitis, osteochondritis, and lucent
rash mainly on the face, palm, and soles. epiphyseal bands.

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442 Rowe et al

swelling and/or inflammation of the elbows and infection. Nontreponemal tests include the venereal
knees.7,24 Early diagnosis is important to prevent pro- disease research laboratory (VDRL) and the rapid
gression to LCS and severe, long-term sequelae.25,26 plasma reagin (RPR), which measure the levels of
IgG and IgM antibodies.27 These antibodies can be
Lifelong Implications of Congenital Syphilis detected as soon as 6 days after bacterial invasion.27
Infants affected by CS are at risk for severe, lifelong The RPR is predominantly used for serum testing
sequelae associated with the disease. If unidentified and the VDRL for cerebrospinal fluid testing.25 A
and/or left untreated, the disease can progress to positive screen should be followed by a treponemal
organ damage, including heart failure; brain damage test, which is more specific.23,27
and infections, which can result in seizures and The treponemal serology tests are used for confir-
paralysis; and deformities of the arms and legs mation of the presence of the bacteria and detect
resulting in immobility.7,8 Other detrimental conse- antibodies against T. pallidum antigens.23,27 Trepo-
quences may include growth restrictions, hearing nemal tests include fluorescent treponemal anti-
loss, blindness, and death.7,8 These medical implica- body-absorbed test, microhemagglutination assay
tions exacerbate the emotional and economic bur- for T. pallidum, enzyme-linked immunosorbent
dens faced by families due to the need for frequent assays, and Treponemal IgM in serum.27,29 Trepone-
follow-ups aimed at limiting these sequelae; this mal tests can detect both IgM and IgG antibodies
highlights the importance of the nurse’s role in early that are specific to T. pallidum.27 These antibodies
identification of the disease.8 remain positive for life; therefore, positive results
need to be verified with nontreponemal testing to
DIAGNOSIS OF CONGENITAL SYPHILIS determine past versus active infection.
Although used less commonly, polymerase chain
The easy transfer of immunoglobulin (Ig) G antibod- reaction techniques used to amplify and detect the T.
ies across the placenta to the fetus makes the diagno- pallidum DNA in tissue and body fluid samples are
sis of CS challenging in the fetal and early neonatal more reliable due to rapid turnaround times, valid-
period, as it can complicate the interpretation of ity, sensitive detection of T. pallidum, and diagnostic
serologic tests in the neonate.1,11 Prenatal testing for accuracy.27,30 These characteristics of polymerase
CS can also be complicated by the inability to suc- chain reaction enable rapid diagnosis and implemen-
cessfully culture the T. pallidum bacteria.2 Direct tation of treatment.30 Dark-field microscopy or
visualization of the spirochete and serologic testing immunofluorescent staining can be performed to
continue to be the gold standard for diagnosing the directly visualize the bacteria in fluid samples from
infection due to these perplexities, with serologic lesions and infected tissues.27
testing the more common due to cost-effectiveness, The presence of T. pallidum in amniotic fluid or
ease of use, and reliability.2,27 Imaging studies and fetal blood can confirm the diagnosis in utero. Pre-
percutaneous umbilical cord blood sampling can natal ultrasounds may also reveal features that are
also aid in the diagnosis.28 suggestive of CS including hepatomegaly, spleno-
megaly, placentomegaly, and fetal growth restric-
Prenatal Diagnosis tion.28 Prenatal screening allows for prompt treat-
Prenatal screening results in decreased fetal mortal- ment and reduction in the sequelae of CS, highlighting
ity and is the rationale for serologic testing in the the importance of serologic screening at different
early trimesters.23 Positive maternal serologic testing stages of pregnancy.23
during any stage of pregnancy is concerning for
ECS, mandating neonatal testing.23 The Centers for Postnatal Diagnosis
Disease Control and Prevention (CDC) recommends The diverse clinical features of CS can make the diag-
routine testing at the first prenatal visit for all preg- nosis daunting. Assessment should begin with a thor-
nant women, and in the second trimester and at ough physical examination for skin lesions, jaundice,
delivery for high-risk women and those living in mucous membrane fissures or patches, and thick or
high prevalence areas.11 Laboratory serologic testing bloody nasal discharge.19,23 Next, detailed palpation
falls into 2 categories: nontreponemal and trepone- should occur to assesses for organomegaly.19
mal. Direct detection in the form of DNA assessment All infants suspected of having CS should be tested
and visualization of the bacteria are confirmatory with the same nontreponemal tests that were per-
testing methods as well.9 formed on the mother, and the results should be ana-
Nontreponemal tests are nonspecific and may lyzed for the difference in titers.4,23 A positive serum
produce similar results in the presence of other viral IgM in the infant, detected through RPR, is reflective
and bacterial infections, or autoimmune condi- of active syphilis infection because maternal IgM
tions.23,27 Pregnancy can also cause false-positive does not cross the placenta.23 Congenital syphilis is
results. The nontreponemal serology tests are used indicated when the nontreponemal serologic titer in
to both screen and monitor the status of the the infant is fourfold higher than that of the

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 Congenital Syphilis 443

mother.11,23 The American Academy of Pediatrics nontreponemal serologic testing every 3 months
and the CDC recommend that all infants born to until the tests are nonreactive or the titers are less
mothers who were inadequately treated during preg- than fourfold.4
nancy should be further evaluated with complete
blood counts and cerebrospinal fluid analysis for IMPLICATIONS OF CONGENITAL
protein, cell count, and quantitative VDRL.23 Other SYPHILIS
diagnostic tests include eye examinations to assess
for structural abnormalities; chest and long bones Congenital syphilis is a preventable disease; timely,
radiography, which may show radiolucency, osteo- adequate treatment of the pregnant woman affected
chondritis, periostitis, bone destruction, and opaci- with syphilis can limit the associated emotional,
ties; and liver function tests.23,25 Once diagnosis is social, economic, and medical burdens.10,31 The emo-
made, prompt and adequate treatment is necessary tional loss of a fetus or child can be traumatizing for
to minimize sequelae. parents.31 When losses are caused by congenital infec-
tions, such as syphilis, the psychological effect of the
MANAGEMENT OF CONGENITAL traumatic event can be escalated by feelings of guilt,
SYPHILIS blame, and in some cases, depression in the mother.31
Therefore, implementation of programs that place
Parenterally administered penicillin G is the only focus on the prevention of CS is warranted.31
known effective antimicrobial to treat maternal The economic burden associated with the treat-
syphilis and prevent maternal transfer to the fetus or ment of CS affects not only families, but society as a
newborn.7,9,11 No other antibiotic efficaciously whole.31 The hospitalization cost for an infant affected
destroys the T. pallidum bacteria; therefore, desensi- by CS is as much as 7 times higher, and the length of
tization has to be instituted and the therapy contin- hospital stay is approximately 8 days longer than for
ued in cases of penicillin allergy.2,9,13,23 The efficacy a healthy infant.32 These cost increase estimates do
of intramuscularly administered benzathine penicil- not include postdischarge medical expenses related to
lin G against syphilis is credited to its slow release late CS.32 In comparison, prenatal screening offers a
into the body tissues.13 Management and treatment long-term cost-benefit for public health entities.31
of CS depend on the stage and treatment of maternal
disease, clinical manifestations, and evaluation of IMPLICATIONS FOR NURSING
the findings in the infant (Table 1).23 PRACTICE
Diagnosis made later in infancy is subject to more
aggressive and more frequent dosing due to the risk Nurses play an integral role in the detection, early
of neurosyphilis.23 The infant diagnosed with CS implementation of treatment, effective management,
should have structured follow-up that includes and elimination of CS.33 The expert knowledge

TABLE 1. Management of Confirmed, Suspected, and Asymptomatic-Confirmed Congenital

Syphilis
Criteria Treatment Regimen
Confirmed or highly probable CS4,6,9,23 Aqueous crystalline penicillin G 50,000 μ/kg/dose IV
•  Abnormal PE or •  Q12 h × 7 d followed by
•  Serological titer >4-fold maternal titer or •  Q8 h × 3 d OR
•  Positive DFM or PCR Procaine penicillin G 50,000 μ/kg/dose IM daily × 10 d
Possible CS4,6,9,23 As above OR
•  Normal PE, titers ≤4-fold and inadequately treated Benzathine penicillin G 50,000 μ/kg/dose IM × 1 dose
mother
Less likely CS4,6,9,23 Benzathine penicillin G 50,000 μ/kg/dose IM × 1 dose
•  Normal PE and adequately treated mother
Unlikely CS4,23 No treatment OR
•  Normal PE, adequately treated mother, and low ma- Benzathine penicillin G 50,000 μ/kg/dose IM × 1 dose
ternal serologic titer
Symptomatic diagnosed CS4,23 Aqueous crystalline penicillin G 50,000 μ/kg/dose IV
•  Reactive serologic tests with clinical manifestations •  Q4-6 h × 10 d
Asymptomatic diagnosed CS4,23 Benzathine penicillin G 50,000 μ/kg/dose IM weekly μ
•  Reactive serologic test without clinical manifestations 3 wk
Abbreviations: CS, congenital syphilis; DFM, dark-field microscopy; IM, intramuscular; IV, intravenous; PCR, polymerase chain reaction;
PE, physical examination.

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444 Rowe et al

Summary of Recommendations for Practice and Research

What we know: • Congenital syphilis has remained persistent and is on the rise in the United
States.
• Syphilis left untreated during pregnancy can increase morbidity in infants and
mortality of the fetus, neonate, or infant.
•  Penicillin G effectively treats syphilis and congenital syphilis.
What needs to be studied: • Why syphilis is more prevalent in certain geographical areas and certain
ethnicity.
•  Reasons for lack or inadequacy of treatment during pregnancy.
•  The effects of penicillin G on the fetus.
What we can do today: •  Follow WHO and CDC guidelines for testing during pregnancy.
•  Treat infected mothers with penicillin as recommended by the WHO and the
CDC.
•  Ensure all mothers have been screened for syphilis before the infant is dis-
charged from the hospital.
• Structured follow-up of affected infants.

possessed by neonatal nurses and neonatal nurse prac- prenatal screening and adequate penicillin treat-
titioners empowers them to be vigilant in gathering ment.19,20,25 Syphilis left untreated during pregnancy
comprehensive pertinent maternal history and per- poses the greatest risk of severe irreversible sequelae
forming careful detailed physical examinations of the and/or fetal, neonatal, and infant death.4 Vigilant
newborn. Ordering the appropriate diagnostic tests; prenatal and at delivery screening, treatment of the
correctly interpreting results; initiating timely treatment infected mother during pregnancy, meticulous
and management strategies; and preparing the infant assessment of the newborn, and prompt initiation of
for structured follow-up while effectively communicat- treatment with benzathine penicillin G when indi-
ing the plan of care to the family are all activities that cated, along with appropriate follow-up postdis-
neonatal nurse practitioners are efficient at.7,8,15,33 charge, are crucial in reducing the incidence of CS
The maternal history will provide pertinent infor- and constraint of negative sequelae.4,11,15,25 Neonatal
mation regarding the need for further diagnostic eval- nurses are experts in newborn care, advocates at the
uation of the neonate. Newborns of mothers with a bedside, and knowledgeable about infectious dis-
reactive nontreponemal or treponemal serologic test eases; as such, they have a critical role in the inter-
or who never received syphilis screening during preg- professional strategic approach to decrease the inci-
nancy should have serologic testing done in the form dence and limit the severe sequelae of CS.
of RPR or VDRL prior to hospital discharge.9,11 Bed-
side registered nurses are influential in ensuring that References
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