Congenital syphilis and fluorescent treponemal antibody test reactivity after the age of 1 year.
BACKGROUND
Many believe that a persistently reactive fluorescent treponemal antibody absorption (FTA-ABS) is manifested with congenital syphilis after the age of 1 year, that it is useful in the retrospective diagnosis of children with congenital syphilis, and that it can be used to confirm other treponemal tests.


OBJECTIVE
To determine whether a reactive FTA-ABS after the age of 12 months is indicative of congenital syphilis.


METHODS
Prospective outpatient follow-up evaluation until at least the age of 12 months was conducted for 194 babies born to mothers with reactive syphilis serology at delivery, and for two additional children with congenital syphilis diagnosed when they were younger than 1 year (total, 196 children).


RESULTS
In the study group, 54 children had reactive FTA-ABS (reactors) until the age of at least 12 months or more, and 142 children had nonreactive FTA-ABS (nonreactors) at the age of 12 months or more. Of the 54 reactors, 17 (31%) had evidence of congenital syphilis at birth, whereas evidence of congenital syphilis was seen in 14 of the 142 (10%) nonreactors (P = 0.0002). At 15 months, nonreactive FTA-ABS developed in six reactors, and eventually in 15 of 44 reactors (34%) tested.


CONCLUSIONS
A reactive FTA-ABS may be seen at 12 months in children with and without evidence of congenital syphilis at birth. Not all children with congenital syphilis will manifest reactive FTA-ABS at 12 months, and FTA-ABS reactivity wanes with time.
Rawstron
S A
SA
Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Medical Center of Brooklyn, Kings County Hospital Center and SUNY Downstate, Brooklyn, New York 11203-2098, USA.
Mehta
S
S
Marcellino
L
L
Rempel
J
J
Chery
F
F
Bromberg
K
K
D000367:Age Factors; D015153:Blotting, Western; D002308:Cardiolipins / Q000134:cerebrospinal fluid; D002784:Cholesterol / Q000134:cerebrospinal fluid; D019085:Fluorescent Antibody Technique, Direct; D016508:Fluorescent Treponemal Antibody-Absorption Test / Q000592:standards*; D005500:Follow-Up Studies; D006529:Hepatomegaly; D006801:Humans; D007223:Infant; D010713:Phosphatidylcholines / Q000134:cerebrospinal fluid; D012680:Sensitivity and Specificity; D013163:Splenomegaly; D013590:Syphilis, Congenital / Q000097:blood / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000276:immunology; D013997:Time Factors
D002308:Cardiolipins; D010713:Phosphatidylcholines; C054448:VDRL antigen; D002784:Cholesterol