Regarding A Baby born To A Mother With A History Of Syphillis

You are caring for a newborn infant of a mother who reports a history of syphilis but had uncertain treatment and no follow-up evaluation for her disease. Which of the following is most useful in determining whether the child has congenital syphilis?

A. Venereal Disease Research Laboratory test (VDRL)
B. Blood culture
C. Dark field microscopy of a vaginal swab specimen
D. Physical examination for abnormalities
E. Umbilical cord culture

Answer : A. Venereal Disease Research Laboratory test (VDRL)

Discussion:  Mothers infected with syphilis may transmit the disease to their children either by direct contact of an active lesion or through the bloodstream, transplacentally. In most instances, the children will have a normal physical examination and diagnostic testing must be performed to determine whether the child has been infected. In adults, the VDRL test is a sensitive test for diagnosing syphilis and is generally confirmed by obtaining an FTA-ABS. In the newborn, the VDRL may be positive either falsely or because of maternal infection and thus is not useful in screening the newborn. The FTA-ABS is a test specific for syphilis that would be positive in the infant with congenital syphilis and would not be affected by maternal infection unless the disease had been transmitted to the infant; however, there are no currently available recommended commercial tests for FTA-ABS IgM. Thus, in the infant, VDRL titers exceeding those of the mother, along with risk of infection based on the maternal history and findings, determine the need for further testing or treatment. Other findings that support a diagnosis of congenital syphilis include physical or x-ray findings of congenital syphilis, positive CSF VDRL, or elevated CSF cell count or protein. VDRL titers can be followed to determine response to therapy, and with successful therapy should decline. Blood or swab cultures are not helpful in diagnosing syphilis. Dark field microscopy is a useful test for diagnosing syphilis and must be prepared from active lesion (e.g., nasal discharge), the placenta, or the umbilical cord.