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1.
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Saddle nose, mulberry molars, and poorly developed maxillae all suggest late congenital syphilis
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(i.e. that which remains untreated after 2 years of age). |
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2.
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Treponemic [fluorescent treponemal antibody absorption (FTA-ABS); |
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micro haemagglutination assay for treponema pallidum (MHA-TP)] |
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and non-treponemal [venereal disease research laboratory (VDRL)] serology. FTA and VDRL of cerebrospinal fluid (CSF). |
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3.
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Asymptomatic neurosyphilis may be present in one-third of untreated patients, |
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while clinical neurosyphilis occurs in one-quarter of patients |
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over 6 years of age with untreated congenital syphilis. |
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4.
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Penicillin. The response of benign latent syphilis to penicillin G is impressive, with progression arrested. |
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If CSF is 'normal', treatment is with intramuscular (IM) benzathine benzylpenicillin 2.4 million units (U) administered once-weekly for 3 weeks.
If CSF is abnormal, treatment is with aqueous penicillin G 12-24 million U/day administered in divided doses every 4 hours for 10-14 days OR aqueous procaine penicillin G 2.4 million U/day IM plus oral probenecid 500 mg four times daily for 10-14 days.
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