At birth, the spirochetemia may not have had time to cause syphilitic antibodies to appear; hence a negative Venereal Disease Research Laboratory (VDRL) reaction in umbilical cord blood does not exclude congenital syphilis. In unselected groups of syphilitic mothers, 25 to 80 percent of fetuses have been infected, and in 20 to 40 percent of those infected, the CNS is invaded as judged by the finding of abnormal CSF. The types of congenital neurosyphilis (asymptomatic and symptomatic meningitis, meningovascular disease, hydrocephalus, general paresis, and tabes dorsalis) are the same as those in the adult except for the great rarity of tabes dorsalis. The classic Hutchinson triad (dental deformities, interstitial keratitis, and bilateral deafness) is infrequently observed in complete form.
The sequence of neurologic syndromes is also the same as in the adult, all stemming basically from chronic spirochetal meningitis. The infection may become symptomatic in the first weeks and months of postnatal life, meningovascular lesions and hydrocephalus reaching maximal frequency during the period from 9 months to 6 years. An early form of syphilitic meningoencephalitis may occur at 1 to 2 years and result in severe developmental delay. More often, a congenital paresis and tabes usually appear between the ninth and fifteenth years. The pathologic basis of the neurosyphilitic syndromes is discussed in Chap. 31.
Fewer cases of congenital neurosyphilis are being observed as the years pass, but there may be a recrudescence of the disease in HIV-infected patients. If the syphilitic mother is treated before the fourth month of pregnancy, the fetus will not be infected. The affected infant may be normal at birth or exhibit only mucocutaneous lesions, hepatosplenomegaly, lymphadenopathy, and anemia. In the neonatal period, there are no signs of meningeal invasion, or there may be only asymptomatic meningitis. If the latter is actively treated until the CSF is normal, vascular lesions of brain and spinal cord, hydrocephalus, general paresis, and tabes dorsalis will not develop.
Congenital syphilis must be considered a potential, albeit rare, cause of epilepsy and developmental delay. Once the syphilitic infection has been treated in early life and rendered inactive (acellular CSF, normal protein), the occurrence of a congenital infection can only be substantiated by an accurate history; the finding of the syphilitic stigmata in the eyes, teeth, and ears; or a positive serologic reaction in the CSF.
Treatment of syphilis in the child follows along the same lines as treatment of the syphilitic adult (see Chap. 31), with appropriate adjustment of dosage in accordance with the child’s weight.