Congenital syphilis and perinatal sexually transmitted infections

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Target exams

Red flags

• A hydropic or stillborn infant, or a septic-appearing newborn with hepatosplenomegaly, rash and a blood-tinged nasal discharge — early congenital syphilis until proven otherwise
• A neonate with profuse purulent conjunctivitis at day two to five — gonococcal ophthalmia neonatorum; corneal perforation can occur within hours, so treat with ceftriaxone urgently
• A twelve-to-twenty-one-day-old with skin vesicles, lethargy, poor feeding, seizures or sepsis-like illness — neonatal herpes; start empiric high-dose intravenous acyclovir immediately
• An afebrile infant with a staccato cough and tachypnoea at two to nineteen weeks — chlamydial pneumonia; treat and screen the mother
• A pregnant woman with a positive syphilis screen treated within four weeks of delivery, with a rising titre, or reinfected — the infant is at high risk and needs full evaluation

Life stages

Care settings

Clinical exam formats

Board mappings

• General Paediatrics and Neonatal: congenital syphilis and perinatal STIs — recognition, complications and management
• Antenatal and newborn screening: syphilis serology and the role of maternal treatment in prevention
• Renewed curriculum — Infectious diseases: resurgent congenital syphilis, missed-prevention failures and the public-health response
• Community and population child health: Indigenous and remote-health equity driving the Australian epidemic
• General Paediatrics: the septic or hydropic newborn and neonatal conjunctivitis — diagnosis and management of congenital syphilis and perinatal STIs
• Public health: antenatal screening, notification, partner tracing and maternal treatment adequacy
• Long Case / Structured discussion: congenital syphilis in the newborn — diagnosis, treatment, long-term surveillance and prevention
• Communication station: explaining a positive antenatal syphilis screen, treatment and the prevention of congenital infection to a family
• Level 2 / 3 — Infection and Neonatal: congenital syphilis and vertical STIs as preventable infections; diagnosis, complications and public-health responsibilities
• Public health and safeguarding: antenatal screening, maternal treatment and equity
• Foundation of Practice (FOP): early and late congenital syphilis features, neonatal conjunctivitis by onset day, and neonatal herpes phenotypes
• Applied Knowledge in Practice (AKP): maternal and neonatal serology, benzathine and aqueous penicillin treatment, ocular prophylaxis and neonatal HSV management
• History-taking and management: the newborn with suspected congenital syphilis or perinatal STI
• Communication: explaining a maternal syphilis diagnosis, treatment and the prevention of congenital infection
• General Pediatrics Content Outline — congenital syphilis, ophthalmia neonatorum and neonatal HSV: diagnosis, complications, treatment and prevention
• Infectious Diseases and Neonatal: T. pallidum, N. gonorrhoeae, C. trachomatis and HSV; serology interpretation and penicillin dosing
• Bright Futures / perinatal care: antenatal STI screening and neonatal ocular prophylaxis
• Patient Care: diagnosis and stepwise management of congenital syphilis and perinatal STIs across the maternal-neonatal dyad
• Systems-Based Practice and Population Health: antenatal screening, missed-prevention analysis, partner notification and equity
• Medical Knowledge: transplacental spirochaetal pathophysiology and intrapartum HSV and bacterial transmission
• Medical Expert: congenital syphilis, ophthalmia neonatorum and neonatal HSV diagnosis, complications and management
• Health Advocate and Collaborator: antenatal screening, Indigenous and remote-health equity, partner treatment and notification
• Communicator: explaining a maternal STI diagnosis, treatment and the prevention of congenital infection to families