Penicillin Treatment for Congenital Syphilis: A Critical Reappraisal

The asymptomatic infant with suspected congenital neurosyphilis poses a diagnostic and therapeutic problem. Because cerebrospinal fluid serologic studies may be falsely reactive, the clinician is frequently forced to treat infants as if they have neurosyphilis despite the lack of confirmatory laboratory data. There are very few clinical studies to indicate the proper dosage and preparation of penicillin for treatment of congenital syphilis. The current recommendations for treatment make no distinction for infants with or without neurosyphilis. Revised treatment schedules for congenital syphilis with or without central nervous system disease are proposed in accordance with the available pharmacologic data and in the absence of adequate clinical experience. (JAMA 228:855-858, 1974).