Clinical and serologic evaluation of neonates for congenital syphilis: a continuing diagnostic dilemma.
Neonates born to women with reactive serologic tests for syphilis were studied; the total of 116 included 18 who were symptomatic, 60 asymptomatic but possibly infected, and 38 asymptomatic and probably uninfected. The fluorescent treponemal antibody-absorption (FTA-ABS) 19S IgM test and an IgM capture ELISA for Treponema pallidum, both treponema-specific assays, and the reverse enzyme-linked immunospot (RELISPOT), which detects immunoglobulin-secreting cells and is a nonspecific indicator of infection, were evaluated. Sensitivities among symptomatic neonates were 88% (IgM ELISA), 73% (FTA-ABS), and 78% (RELISPOT). Specificities ranged from 97% to 100%. A major problem has been the inability to identify which asymptomatic but possibly infected neonate is really uninfected. Among 41 such babies who had all three tests done, 93% were negative by all assays, suggesting they were uninfected or recently infected. Strategies to accurately identify the truly uninfected asymptomatic newborn would prevent the unnecessary hospitalization of all at-risk infants, resulting in improved quality of care and reduced costs.
Stoll
B J
BJ
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30335.
Lee
F K
FK
Larsen
S
S
Hale
E
E
Schwartz
D
D
Rice
R J
RJ
Ashby
R
R
Holmes
R
R
Nahmias
A J
AJ
D000328:Adult; D004797:Enzyme-Linked Immunosorbent Assay; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007118:Immunoassay / Q000379:methods; D007231:Infant, Newborn; D008297:Male; D013590:Syphilis, Congenital / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology