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The Pediatric Forum
October 1998

Congenital Syphilis in Newborn Infants—Reply

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Copyright 1998 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1998

Arch Pediatr Adolesc Med. 1998;152(10):1041. doi:

In reply

We appreciate the careful reading by Drs Rawstron and Bromberg of our article on the topic of the usefulness of long-bone radiographs in diagnosing active congenital syphilis.1 They are correct in pointing out a typographical error in the Table; in fact, there are 2 errors in the Table, and 1 in the text. With regard to their second, third, and fifth concerns, all of our patients were evaluated as recommended by published guidelines (including cerebrospinal fluid evaluations); data on the results of other tests are not reported because this was not a study of the wisdom of performing lumbar punctures or any other test. This was a study of the wisdom of ordering long-bone radiographs in the evaluation of congenital syphilis. If they are interested, several articles have been published on the use of lumbar punctures in the evaluation of congenital syphilis. Their fourth and sixth concerns are most worrisome to us, as they indicate that we did not make our point sufficiently clear. Rawstron and Bromberg assume in their comments that abnormal long-bone films are diagnostic of active congenital syphilis; that they are not is the point of our article. As has been previously demonstrated and is confirmed by our data, long-bone films are nonspecific for syphilis. An abnormal film does not mean that an infant has congenital syphilis, and a normal film does not mean that an infant does not have congenital syphilis. Further, even when positive, the long-bone films do not have any prognostic significance. As a result, knowing the result of the long-bone films will not help us to detect infants with congenital syphilis and will not help us decide what treatment is needed. Parents expect their child's pediatrician to practice fact-based medicine. We hope that our data will provide pediatricians with data to decide on diagnosis and appropriate treatment, and that patients will therefore be subjected only to the most necessary and useful tests and procedures. The resources that are spent on long-bone films might be better spent on intensive follow-up, during which the conditions of some infants can be definitively diagnosed. This would, in fact, represent the "best attempt" to make the diagnosis given current technology. We and many others await refinement of such tests as immunoglobulin M and perhaps even polymerase chain reaction so that we can satisfy our intellectual and scientific curiosity with accurate information and better choose the infants who truly need treatment.

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