Management of neonates born to a birthing parent with syphilis
Manage neonates born to a birthing parent (eg mother) with syphilis in consultation with an expert.
Neonates are at low risk of congenital syphilis if the birthing parent with a positive serological test result or active syphilis hasStafford, 2024Workowski, 2021:
- received adequate penicillin treatment 4 weeks or longer before delivery
- documented adequate serological response to treatment before or at delivery
- a partner who was adequately treated simultaneously, and the birthing parent was not re-infected.
Thoroughly examine and investigate neonates of birthing parents with syphilis for congenital syphilis. Testing includes syphilis serology and nucleic acid amplification testing (NAAT) (eg polymerase chain reaction [PCR]) testing of any lesions or secretions from the neonate. If possible, perform NAAT and histopathology on the placenta. For more information on recommended investigations, see the Australasian Society for Infectious Diseases (ASID) Management of Perinatal Infections guidelines.
The diagnosis of congenital syphilis is suggested by any of the following:
- abnormal clinical examination with or without abnormal radiology (eg long-bone X-ray or cranial ultrasound)
- rapid plasma reagin (RPR) titres 4-fold higher than the birthing parent’s titres
- a positive NAAT result of mucosal lesion swabs or biopsy, tissue, cerebrospinal fluid (CSF) or placenta
- a positive Treponema pallidum-specific IgM test result.
For the treatment of suspected or confirmed congenital syphilis in neonates, under expert guidance, useAustralian Society for Infectious Diseases (ASID), 2022British Association for Sexual Health and HIV (BASHH), 2019Workowski, 2021:
benzylpenicillin 30 mg/kg intravenously, for 10 days benzylpenicillin
neonate 7 days or younger: 12-hourly
neonate older than 7 days: 8-hourly.
For well neonates who are at low risk of congenital syphilis (see above), if follow-up is likely to be logistically difficult (eg in remote areas), a single intramuscular dose of benzathine benzylpenicillin may be administered pending syphilis investigations. Consult local guidelines and seek expert advice to assess whether this option is suitable. If appropriate, useWorkowski, 2021:
benzathine benzylpenicillin 50 000 units/kg (0.1 mL/kg) intramuscularly, as a single dose1. benzathine benzylpenicillin
Benzathine benzylpenicillin is long acting. Do not confuse benzathine benzylpenicillin with benzylpenicillin, which is short acting.
For more information about the management of a neonate born to a birthing parent with syphilis, see the Australasian Society for Infectious Diseases (ASID) Management of Perinatal Infections guidelines.