Congenital neurosyphilis: a re-appraisal.

An investigation was undertaken to determine the presence and incidence of neurosyphilis in cases of congenital syphilis. Twenty infants, diagnosed as having congenital syphilis on the basis of a positive serum fluorescent-treponemal-antibody-absorbed immunoglobulin M (FTA-IgM) test, were studied. Eleven had clinical disease, while 3 had non-specific illnesses, but x-rays very suggestive of syphilis. Six were asymptomatic newborns, born of mothers known to have positive VDRL tests. There was no clinical evidence of neurosyphilis. The cerebrospinal fluid (CSF) was definitely abnormal in 2 babies, most likely abnormal in a third, and very doubtfully positive in 2 premature babies. The incidence of neurosyphilis in this series is much lower than that reported in the past. The problems of diagnosing neurosyphilis, and reasons for the low incidence here are discussed.