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Congenital syphilis in neonates with nonreactive nontreponemal test results

Abstract

Objective:

Infants whose mothers had syphilis during pregnancy were studied to determine how often exposed newborns with normal physical examinations and nonreactive nontreponemal serologic tests had abnormal laboratory or radiographic studies.

Study Design:

Retrospective analysis of prospectively collected data from infants born to mothers with syphilis and had a normal examination and a nonreactive nontreponemal test. Some infants had IgM immunoblotting, PCR testing or rabbit infectivity testing (RIT) performed.

Results:

From 1984 to 2002, 115 infants had a nonreactive serum Venereal Disease Research Laboratory (VDRL)/rapid plasma reagin (RPR) test and a normal physical examination at birth. Among 87 infants born to mothers who had untreated syphilis, 4 had a positive serum IgM immunoblot or PCR test, but none had spirochetes recovered by RIT. Two infants had anemia, one had an elevated serum alanine aminotransferase concentration and one with Down’s syndrome had direct hyperbilirubinemia. Among 14 infants born to mothers treated <4 weeks before delivery, none had abnormal laboratory or radiographic tests, although 1 of 11 had a reactive serum IgM immunoblot. Among 14 infants born to mothers treated 4 weeks before delivery, none had abnormal laboratory or radiographic tests.

Conclusion:

Newborns with normal physical examination and nonreactive nontreponemal test results are unlikely to have abnormalities detected on conventional laboratory and radiographic testing.

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Acknowledgements

We thank Michael V Norgard, PhD, Professor and Chair of Microbiology at the University of Texas Southwestern Medical Center, Dallas, TX for superb mentorship (PJS) as well as guidance and supervision of the research methodologies used in this study. This study was presented, in part, at the Pediatric Academics Societies Meetings, 25 to 28 April 2015 in San Diego, California. This work was supported by the National Institutes of Health (1 R29 AI 34932-01 to PJS) and Centers for Disease Control and Prevention (C1000 689 to PJS, GDW).

Author contributions

PSW helped to conceptualize and design the study, analyzed the data, draft the initial manuscript and approved the final manuscript as submitted.

JBC helped to conceptualize and design the study, analyzed the data, reviewed and revised the manuscript and approved the final manuscript as submitted.

FZ helped to design the study, collected and analyzed the data, reviewed the manuscript draft and approved the final manuscript as submitted.

NKL helped to design the study, performed laboratory testing, analyzed the data and approved the final manuscript as submitted.

JSS helped to design the study, analyzed the data, reviewed the manuscript draft and approved the final manuscript as submitted.

GDW helped to conceptualize and design the study, performed the laboratory testing, analyzed the data, reviewed the manuscript draft and approved the final manuscript as submitted.

PJS helped to conceptualize and design the study, collected and analyzed the data, performed the laboratory testing, reviewed and revised the manuscript and approved the final manuscript as submitted.

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to P J Sánchez.

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Wozniak, P., Cantey, J., Zeray, F. et al. Congenital syphilis in neonates with nonreactive nontreponemal test results. J Perinatol 37, 1112–1116 (2017). https://doi.org/10.1038/jp.2017.103

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