Overview
Late congenital syphilis refers to syphilis diagnosed in children aged 2 years or older who acquired the infection congenitally. This presentation can be asymptomatic or manifest with a variety of signs and symptoms reflecting chronic infection and its sequelae.Diagnosis
Diagnosis relies on a combination of clinical findings, serological tests (treponemal and non-treponemal), and sometimes imaging.
Non-treponemal tests (NTTs) are used for screening and monitoring treatment response, while treponemal tests confirm past infection.
Point-of-care (POC) tests are available for syphilis diagnosis 1.Management
Penicillin G benzathine is the recommended treatment for late congenital syphilis.
Azithromycin is excluded as an alternative treatment at any stage of syphilis 1.Special Populations
Pregnancy: Pregnant individuals require prompt diagnosis and treatment to prevent congenital syphilis in their offspring.
Pediatrics: Management of congenital syphilis in children, including late presentations, is guided by specific pediatric protocols.Key Recommendations
Azithromycin should not be used as an alternative treatment for syphilis at any stage 1. (Evidence: Strong)
Benzathine penicillin G remains the primary treatment for syphilis 1. (Evidence: Strong)
Dual treponemal and non-treponemal point-of-care tests are available for syphilis diagnosis 1. (Evidence: Moderate)References
1 Janier M, Unemo M, Dupin N, Tiplica GS, Potočnik M, Patel R. 2020 European guideline on the management of syphilis. Journal of the European Academy of Dermatology and Venereology : JEADV 2021. link