NCLEX Review Guide: Congenital Syphilis in Newborns

Definition and Transmission

• Congenital syphilis is a multisystem infection caused by Treponema pallidum transmitted from infected mother to fetus through placental circulation, typically after 18 weeks gestation.
• Transmission can occur at any stage of pregnancy, but risk is highest when maternal infection is primary or secondary (early stages with high bacterial load).

Early Congenital Syphilis (Birth to 2 years)

• Skin manifestations: Copper-colored maculopapular rash on palms and soles, bullous lesions, condylomata lata around anus and genitals.
• Systemic signs: Hepatosplenomegaly, lymphadenopathy, anemia, thrombocytopenia, and failure to thrive.
• Rhinitis ("snuffles"): Persistent nasal discharge that is highly contagious and can cause nasal cartilage destruction.

Late Congenital Syphilis (After 2 years)

• Hutchinson's triad: Hutchinson's teeth (notched central incisors), interstitial keratitis, and eighth cranial nerve deafness.
• Skeletal abnormalities including saber shins, saddle nose deformity, and frontal bossing of skull.

Laboratory Tests

• Non-treponemal tests: VDRL and RPR measure antibody response; titers should be 4x higher than maternal levels to indicate active infection.
• Treponemal tests: FTA-ABS and TP-PA detect specific antibodies; remain positive for life even after treatment.
• CSF analysis: Required if neurosyphilis suspected; elevated protein, cell count, and positive VDRL indicate CNS involvement.

Pharmacological Treatment

1. Penicillin G is the drug of choice: 50,000 units/kg IV every 12 hours for first 7 days, then every 8 hours for total 10-day course.
2. Alternative regimen: Procaine penicillin G 50,000 units/kg IM daily for 10 days if IV access difficult.
3. No penicillin alternatives: Desensitization required if penicillin allergy suspected.

Nursing Interventions

• Contact precautions: Maintain until 24 hours after treatment initiation due to infectious lesions and nasal discharge.
• Monitor for Jarisch-Herxheimer reaction: fever, tachycardia, hypotension occurring 2-8 hours after first penicillin dose.
• Assess neurological status regularly including hearing, vision, and developmental milestones throughout treatment.
• Provide supportive care for skin lesions with gentle cleansing and barrier protection to prevent secondary infection.