July 2026 – Question of the Month
A full-term female infant is born to a 24-year-old mother who had limited prenatal care. Maternal syphilis screening at delivery reveals a reactive treponemal test and an RPR titer of 1:128. The mother reports receiving treatment during pregnancy but has no documentation and has had a new sexual partner after treatment.
The newborn appears well. Physical examination is normal. Laboratory evaluation reveals:
• Infant RPR: 1:64
• CBC: Normal
• Liver enzymes: Normal
• CSF VDRL, cell count, and protein: Normal
• Long-bone radiographs: Normal
Which of the following is the most appropriate management for this infant?
Correct!
Wrong!
EXPLANATION
Although the infant's examination and diagnostic evaluation are normal and the infant's RPR titer is less than fourfold that of the mother, the maternal history is inadequate to exclude congenital infection because treatment is undocumented and reinfection is possible. This infant meets criteria for Possible Congenital Syphilis and should receive 10 days of intravenous aqueous penicillin G.