Congenital syphilis in Lusaka. I. Incidence in a general nursery ward.

A prospective study currently is underway at the University Teaching Hospital Zambia to assess the potential risk of pregnancy wastage related to syphilis and the risk of congenital syphilis in neonates. The study was conducted from December 1980 to April 1981. The patients were 233 consecutive infants under age 3 months who were admitted for various ailments. Cases of tetanus and gastroenteritis were excluded. Irrespective of the clinical presentation these infants were examined routinely for clinical signs of congenital syphilis and RPR test on serum was performed. Reactive sera were confirmed by TPHA test. Darkfield examinations were made from skin and mucous lesions when present. In all cases of suspected congenital syphilis X-rays of long bones were taken and CSF was examined. Mothers of these infants were interviewed and examined for syphilis. The 5 major diagnoses made in this group of infants were: respiratory infections (54.5%); congenital syphilis (8.6%); neonatal jaundice (7.7%); septicemia (7.3%); and pyoderma (5.2%). Presumptive diagnosis of congenital syphilis was made in 20 infants who had reactive serological tests and compatible clinical features. Hepto-splenomegaly was the most common finding in these infants; skin rash was seen in only 8 (40%). Darkfield smears for T. pallida were positive in 3 cases. X-rays of long bones revealed periosteal cloaking in all the 20 infants with definite metaphysical changes in 9 infants. Anemia with Hb less than 10 g/dl also as observed in 18 infants (90%). CSF was reactive for RPR and TPHA in 6 (30%) and increased proteins and cells were observed in only 1 infant who also had clinical signs of meningitis. The majority of the women were multiparous had a low socioeconomic status and many delivered at home. 11 women attended antenatal examinations and 3 of them with positive VDRL received treatment in the last trimester of pregnancy. In all the 18 mothers RPR was reactive but 8 had a nonreactive test in the early antenatal period. Active secondary syphilitic lesions were observed in 12 months. A total of 65 infants died during the study period including 6 with congenital syphilis.