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Congenital syphilis. Serologic diagnosis in the young infant
1Infectious Diseases Section, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
Insights
Diagnosing congenital syphilis in infants requires combining epidemiological, clinical, and serologic data. New anti-treponemal IgM assays show promise but are not yet reliable for widespread use in diagnosing this infection.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Congenital syphilis diagnosis in newborns and young infants is complex.
- It necessitates integrating epidemiological, clinical, and serologic evidence of infection.
Purpose of the Study:
- To review the current state of diagnostic methods for congenital syphilis.
- To highlight the limitations of existing and emerging serologic assays.
Main Methods:
- Review of available anti-treponemal IgM assays, including 19S-IgM-FTA-ABS and IgM ELISA.
- Discussion of the challenges in diagnosing central nervous system (CNS) involvement by Treponema pallidum.
Main Results:
- New serologic techniques for congenital syphilis have advanced but lack sufficient reliability for widespread clinical use.
- Diagnosing Treponema pallidum CNS involvement remains difficult without a definitive "gold standard".
Conclusions:
- No single serologic assay reliably diagnoses congenital syphilis in young infants.
- Physicians must synthesize epidemiological, clinical, and laboratory data for treatment decisions, including treating all infected infants for potential neurosyphilis.
Abstract:
The diagnosis of congenital syphilis in the newborn or young infant must incorporate epidemiologic, clinical, and serologic evidence of infection. Anti-treponemal IgM assays such as the 19S-IgM-FTA-ABS, which can be performed at the CDC at the request of state health departments, and the IgM ELISA being developed by Ortho Diagnostics represent the most available of the new assays. Discrimination of CNS involvement by T. pallidum by new methods continues to be difficult in the absence of a "gold standard" for comparison; thus, the current recommendation is to treat all infected infants with a regimen adequate to eradicate neurosyphilis. Although tremendous progress has been made in recent years in new serologic techniques applicable to congenital syphilis, none have proved reliable enough yet to be widely used by physicians evaluating infants at risk. In conclusion, there is still no single serologic assay that will reliably diagnose congenital syphilis in the young infant and the weight of therapeutic decisions still rests on the physician's ability to synthesize epidemiological, clinical, and laboratory data.