Congenital Syphilis in Ireland: Symptoms, Causes & Treatment | aihealz
Infectious Disease
Congenital Syphilis.Care & specialists in Ireland
In Ireland, congenital Syphilis is managed by infectious diseases. Congenital syphilis is a vertical infection of the fetus by Treponema pallidum during pregnancy, almost entirely preventable through prenatal screening and timely maternal treatment. The United States recorded 3,761 cases in 2022 — a tenfold rise from 2012 and the highest count in three decades, with 282 stillbirths and infant deaths attributed to it.
aliases · Congenital Syphilis (syphilis passed from mother to baby)· जन्मजात उपदंश (Janmajat Upadansh)· Sífilis Congénita· reviewed May 13, 2026
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Reviewed by AIHealz Medical Editorial Board · Infectious DiseaseLast reviewed May 13, 2026
Congenital syphilis (ICD-10: A50) is infection of a fetus or newborn with Treponema pallidum acquired transplacentally from an untreated or inadequately treated pregnant person, or rarely through direct contact with a maternal genital lesion at delivery. Treponemes can cross the placenta from approximately gestational week 14 onward, with transmission risk depending on maternal stage: 70-100% in primary or secondary maternal syphilis, 40-83% in early latent, and 10% in late latent. Outcomes range from spontaneous abortion (which can occur as early as the second trimester) and stillbirth (up to 40% of cases in untreated maternal infection) through neonatal death, early congenital syphilis (multisystem disease in the first two years), and late congenital syphilis (recognized after age two, often presenting in school age or adolescence with characteristic stigmata). The pathophysiology is direct treponemal invasion of fetal tissues plus immune-mediated injury from chronic spirochete dissemination, producing the classic targets — placenta, liver, bone, central nervous system, eye, ear, and mucocutaneous surfaces.
key facts
Prevalence
3,761 US cases in 2022 (CDC), rate 102 per 100,000 live births — highest since 1991
Demographics
Disproportionate burden in American Indian/Alaska Native (rate ~9x national), Black (~5x), and Hispanic (~3x) infants
Avg. age
Early congenital syphilis: birth to 2 years; late congenital syphilis: ≥2 years to adolescence
Global cases
~700,000 cases of congenital syphilis annually (WHO 2020); >200,000 stillbirths and neonatal deaths
Specialist
Infectious Disease
§ 02
How you might notice it
The key symptoms of Congenital Syphilis are: Persistent rhinitis with white or blood-tinged mucus ("snuffles") from week 1 to 3 months — a treponeme-laden discharge highly infectious to caregivers and often the earliest visible sign., Hepatosplenomegaly with elevated transaminases and direct hyperbilirubinemia, sometimes producing visible jaundice in the first week of life., Maculopapular or vesicobullous rash on the palms, soles, and face, sometimes desquamating — distinct from neonatal physiologic peeling., Generalized lymphadenopathy, particularly epitrochlear (above the elbow), which is uncommon in other neonatal conditions., Painful pseudoparalysis of Parrot — the infant refuses to move an arm or leg due to syphilitic osteochondritis at the metaphysis, sometimes mistaken for fracture or birth trauma., Periostitis and metaphyseal lucencies on long-bone radiographs (Wegner sign, Wimberger sign), present in 60-80% of symptomatic newborns., Failure to thrive, irritability, and low birth weight — nonspecific but common in symptomatic infants..
01Persistent rhinitis with white or blood-tinged mucus ("snuffles") from week 1 to 3 months — a treponeme-laden discharge highly infectious to caregivers and often the earliest visible sign.
02Hepatosplenomegaly with elevated transaminases and direct hyperbilirubinemia, sometimes producing visible jaundice in the first week of life.
03Maculopapular or vesicobullous rash on the palms, soles, and face, sometimes desquamating — distinct from neonatal physiologic peeling.
04Generalized lymphadenopathy, particularly epitrochlear (above the elbow), which is uncommon in other neonatal conditions.
§ 03
How it’s diagnosed
diagnosis
Diagnosis combines maternal serology and history, infant clinical findings, paired infant serology, lumbar puncture, long-bone radiographs, and placental examination, all interpreted against CDC case definitions. The first step is identifying maternal syphilis through routine prenatal RPR or treponemal screening at three time points (first prenatal visit, third trimester, and delivery); the test is mandatory in many US states for any birth, fetal demise after 20 weeks, or stillbirth. When maternal infection is confirmed, every infant born to a syphilis-seropositive mother is evaluated whether they appear well or sick. The CDC algorithm sorts infants into four scenarios based on maternal treatment adequacy and timing, infant nontreponemal titer compared to the mother's, and the presence of clinical or radiographic findings. A confirmed case requires demonstration of T. pallidum by dark-field microscopy or PCR from a lesion, placenta, or autopsy tissue. A presumed case is supported by an infant nontreponemal titer fourfold higher than the mother's, suggestive clinical findings, or a reactive infant IgM by FTA-ABS. Lumbar puncture with CSF VDRL, white cell count, and protein detects asymptomatic neurosyphilis. Long-bone radiographs identify metaphyseal lucencies, periostitis, and Wegner or Wimberger signs in 60-80% of symptomatic newborns. Placental histopathology shows characteristic disproportionately enlarged, pale placenta with necrotizing funisitis. Ophthalmologic examination at birth and audiologic brainstem response testing detect ocular and otic involvement that can otherwise be silent. Late congenital syphilis is diagnosed by clinical recognition of stigmata plus reactive treponemal serology — by adolescence, RPR is often non-reactive in untreated cases.
Key tests
01
Maternal RPR or VDRL with treponemal confirmationIdentifies maternal infection and stage. Mandatory at first prenatal visit, third trimester, and delivery per USPSTF and CDC. A reactive result triggers infant evaluation regardless of maternal treatment status.
02
Infant nontreponemal titer (RPR or VDRL), paired with maternal titer
§ 04
Treatment & cost
medical treatments
✓Aqueous crystalline penicillin G 50,000 units/kg/dose IV q12h × 7 days, then q8h × 3 days
✓Procaine penicillin G 50,000 units/kg/dose IM daily × 10 days
✓Benzathine penicillin G 50,000 units/kg IM single dose
✓Benzathine penicillin G 50,000 units/kg IM weekly × 3 doses (late congenital syphilis)
surgical options
Cosmetic and orthopedic correction of congenital stigmataCosmetic improvement in over 80% of cases; functional results vary by anatomy and timing.
Cochlear implantation for syphilitic deafnessOutcomes comparable to non-syphilitic deafness when implanted in childhood.
§ 05
Causes & risk factors
known causes
Untreated or inadequately treated maternal syphilis
The single proximate cause. Risk of transplacental transmission depends on maternal stage: 60-100% in primary and secondary, 40-83% in early latent, and roughly 10% in late latent. Adequate maternal treatment more than 30 days before delivery virtually eliminates fetal infection.
Missed prenatal screening
USPSTF and CDC recommend serologic screening at the first prenatal visit, third trimester, and delivery. CDC review of 2022 US cases showed over 80% had at least one missed screening opportunity. Late initiation of prenatal care is the dominant systems failure.
Treatment failure or late maternal treatment
Treatment less than 30 days before delivery may not eliminate fetal infection, even when maternal serology declines. Inappropriate antibiotic choice (azithromycin, doxycycline) in pregnancy also fails to cross the placenta reliably and is considered inadequate treatment for the fetus.
Reinfection in pregnancy after initial treatment
Maternal reinfection after early-pregnancy treatment, particularly if a sexual partner was not treated, recapitulates fetal exposure risk. CDC recommends repeat screening in the third trimester and at delivery in any pregnancy with prior syphilis.
Transmission at delivery from genital lesion
Rarely, direct contact between the fetus and an active maternal genital chancre or condyloma lata during vaginal delivery transmits infection. This is the only true congenital route that bypasses placental transit.
risk factors
Untreated maternal syphilismodifiable
§ 06
Living with it
01Universal maternal screening at the first prenatal visit, third trimester, and at delivery — the single most effective preventive intervention
02Same-day treatment with benzathine penicillin G when maternal syphilis is detected, ideally before 28 weeks gestation
03Repeat screening at delivery for any pregnant person at high risk, with rapid point-of-care testing where available
04Concurrent treatment of all sexual partners within the prior 90 days to prevent maternal reinfection
05Penicillin desensitization in any pregnant patient with reported penicillin allergy — no other antibiotic reliably prevents congenital syphilis
06Address barriers to prenatal care: drug treatment, housing, transportation, and engagement support for high-risk pregnancies
recommended foods
•Standard age-appropriate nutrition; breastfeeding is safe and recommended after maternal treatment is established
•Iron-rich foods if anemia from early congenital syphilis was present
§ 07
When to seek help
why see an infectious disease
Pediatric infectious disease consultation is required for any infant with confirmed or probable congenital syphilis, abnormal CSF, abnormal long-bone radiographs, or maternal treatment inadequacy. Neonatologists manage symptomatic newborns; ophthalmology, audiology, neurology, and developmental pediatrics provide long-term follow-up. Late congenital syphilis warrants pediatric ID plus involvement of dental, ENT, and orthopedics for stigmata management.
Stillbirth / fetal demiseDeath in utero attributed to syphilis after 20 weeks of gestation. Occurs in up to 40% of pregnancies with untreated early maternal syphilis. Placental examination shows characteristic enlarged, pale placenta with arteritis.
Early congenital syphilis (birth to age 2)Multisystem disease that may be present at birth or develop within the first 3 months. Features include hepatosplenomegaly, jaundice, rhinitis (snuffles), maculopapular or vesicobullous rash, lymphadenopathy, and osteochondritis or periostitis.
Late congenital syphilis (age ≥2)Surfaces in childhood or adolescence with the classic stigmata: Hutchinson teeth, mulberry molars, saddle nose, frontal bossing, saber shins, interstitial keratitis, eighth-nerve deafness, neurosyphilis, and Clutton joints.
Asymptomatic congenital syphilisTwo-thirds of infected newborns appear well at birth. Detected only through maternal serology and infant evaluation. Without treatment, most progress to early congenital syphilis within 8 weeks.
Probable / possible congenital syphilis (CDC case definitions)Used when serologic, clinical, and CSF findings together do not meet criteria for confirmed disease but suggest infection. Treated empirically while workup completes.
Living with Congenital Syphilis
Timeline
Clinical signs of early congenital syphilis (rash, snuffles, hepatosplenomegaly) resolve over 1-4 weeks of treatment. Bone lesions on radiograph normalize over 3-6 months. Nontreponemal titer (RPR) should drop fourfold by 3 months and become non-reactive by 6-12 months in successfully treated infants. Treponemal tests may remain positive for years or for life regardless of cure. Long-term ophthalmologic and audiologic monitoring extends through adolescence.
Lifestyle
01Attend all scheduled infant follow-up visits at 2, 4, 6, and 12 months for serologic and developmental assessment
02Repeat hearing and vision evaluations annually for the first 5 years to detect late-onset interstitial keratitis or deafness
03Engage with developmental pediatrics if any cognitive or motor delay is noted
04Ensure long-term dental care from age 5 for monitoring of permanent dentition (Hutchinson teeth, mulberry molars)
05Disclose congenital syphilis history to future healthcare providers — informs adolescent and adult medical care
Daily management
01Administer all prescribed antibiotic doses without interruption — missing more than 24 hours of intravenous therapy requires restarting the full course
02Track nontreponemal titer (RPR or VDRL) at 3, 6, and 12 months — should become non-reactive in successfully treated infants
Choosing a doctor
Seek a tertiary care center with neonatology, pediatric infectious disease, and a coordinated congenital infection clinic. Ask whether the center follows the CDC 2021 algorithm with all four scenarios, has pediatric audiology and ophthalmology onsite, and offers long-term follow-up through adolescence. Local public health departments coordinate community follow-up and partner notification.
Congenital syphilis is infection of a fetus or newborn with the bacterium Treponema pallidum, transmitted across the placenta from an untreated pregnant person. It is almost entirely preventable with prenatal screening and timely penicillin treatment. US cases reached 3,761 in 2022, the highest in three decades.
How is congenital syphilis transmitted?▾▴
Treponema pallidum crosses the placenta from approximately gestational week 14 onward, with transmission risk highest in untreated early maternal syphilis (60-100%). Rarely, infection can occur during vaginal delivery through direct contact with an active maternal genital lesion. It is not transmitted by breastfeeding once maternal treatment is established.
Can congenital syphilis be prevented?▾▴
Yes — almost entirely. Universal maternal screening at the first prenatal visit, third trimester, and delivery, with prompt benzathine penicillin G treatment when positive, reduces congenital syphilis to under 2% when treatment is given more than 30 days before delivery. Over 80% of US 2022 cases had at least one missed prenatal screening opportunity.
What are the early signs of congenital syphilis in a newborn?▾▴
Early signs include persistent rhinitis ("snuffles"), enlarged liver and spleen, jaundice, rash on the palms and soles, lymphadenopathy, and refusal to move a limb due to bone inflammation (pseudoparalysis of Parrot). Two-thirds of infected newborns appear well at birth and develop symptoms within the first 3 months.
What are the late signs of congenital syphilis?▾▴
Late congenital syphilis appears after age 2 with the Hutchinson triad: peg-shaped notched upper central incisors, interstitial keratitis, and eighth-nerve sensorineural deafness. Other stigmata include saddle nose, saber shin, frontal bossing of the skull, and Clutton joints. These structural changes do not reverse with treatment but do not progress.
How is congenital syphilis diagnosed?▾▴
Diagnosis combines maternal serology, infant nontreponemal titer compared to the mother's, infant physical exam, lumbar puncture for neurosyphilis, long-bone X-rays, and placental examination. Confirmed cases require direct visualization of treponemes by dark-field microscopy or PCR from a lesion, placenta, or autopsy tissue.
What is the treatment for congenital syphilis?▾▴
Confirmed or highly probable early congenital syphilis is treated with 10 days of intravenous aqueous crystalline penicillin G (50,000 units/kg/dose every 12 hours for 7 days, then every 8 hours). Asymptomatic infants of inadequately treated mothers may receive a single dose of benzathine penicillin G. Late congenital syphilis receives three weekly benzathine penicillin G injections.
Will a baby with congenital syphilis recover fully?▾▴
Asymptomatic newborns treated promptly usually have no long-term sequelae. Symptomatic infants respond clinically over weeks with normalization of lab and X-ray findings over months. Pre-existing damage (deafness, intellectual disability, structural stigmata) may persist but treatment halts ongoing disease. Long-term ophthalmology and audiology follow-up are essential.
Why is congenital syphilis rising in the United States?▾▴
US cases rose tenfold from 2012 to 2022 due to rising adult syphilis rates, missed prenatal screening (over 80% of cases had at least one missed opportunity), late prenatal care, methamphetamine and opioid use in pregnancy, and disparities in healthcare access. CDC has declared the resurgence a public health emergency.
Does congenital syphilis cause stillbirth?▾▴
Yes. Untreated maternal early syphilis causes stillbirth in up to 40% of pregnancies and neonatal death in another 8-15%. Placental examination shows characteristic enlarged pale placenta with necrotizing funisitis. Routine prenatal screening at three time points prevents most of these outcomes.
Can a mother breastfeed if she has had syphilis treated in pregnancy?▾▴
Yes. Breastfeeding is safe once maternal treatment is established and there are no active genital, breast, or nipple lesions. Syphilis is not transmitted through breast milk in the absence of a lesion. The CDC and AAP both endorse breastfeeding in treated mothers.
What is the Hutchinson triad?▾▴
The Hutchinson triad is a classic combination of three late congenital syphilis stigmata: peg-shaped notched upper central incisors (Hutchinson teeth), interstitial keratitis (corneal inflammation causing visual impairment), and eighth-nerve sensorineural deafness. It typically manifests between ages 5 and 15 in untreated cases.
What are Hutchinson teeth?▾▴
Hutchinson teeth are abnormalities of the permanent upper central incisors caused by treponemal damage to the tooth bud in utero. The teeth erupt smaller than normal, widely spaced, peg- or screwdriver-shaped with a notched biting edge. They appear at age 6-7 when permanent incisors emerge and persist for life.
What is the risk if my partner has untreated syphilis during my pregnancy?▾▴
Significant. An untreated partner can reinfect a treated pregnant person, recapitulating risk to the fetus. CDC recommends presumptive treatment of all sexual partners within the prior 90 days of a maternal syphilis diagnosis. Repeat maternal screening in the third trimester and at delivery is also essential.
If I had congenital syphilis as a child, can I pass it to my own children?▾▴
No, not from your past infection. Vertical transmission to the next generation does not occur unless you acquire a new syphilis infection during pregnancy. Standard prenatal screening protocols apply. Disclose your history to your obstetric provider to ensure appropriate follow-up.
Is the penicillin shot painful for the baby?▾▴
Intramuscular or intravenous penicillin causes brief discomfort similar to other neonatal injections. Adequate pain control with non-pharmacologic measures (swaddling, sucrose solution) and topical anesthetic at IV access sites is standard. The treatment is well tolerated overall and is the only proven cure.
What follow-up does a baby treated for congenital syphilis need?▾▴
Nontreponemal titer at 2-3, 6, and 12 months — should drop fourfold by 3 months and become non-reactive by 6-12 months. Ophthalmology and audiology evaluations are repeated annually through age 5 and as clinically indicated through adolescence. Developmental milestones are tracked closely in the first 2 years.
Does congenital syphilis affect hearing?▾▴
Yes. Sensorineural hearing loss from eighth-nerve involvement occurs in roughly 3-10% of late congenital syphilis cases, often bilateral and progressive. If detected early, treatment may halt or partially reverse the loss; longstanding deafness is permanent and may benefit from amplification or cochlear implantation.
Can a baby be born with congenital syphilis if the mother was treated?▾▴
Adequate maternal treatment more than 30 days before delivery virtually eliminates congenital infection. Treatment less than 30 days before delivery, treatment with non-penicillin antibiotics, or reinfection after initial treatment can result in congenital syphilis despite documented treatment. Every infant of a syphilis-seropositive mother is evaluated.
What is snuffles?▾▴
Snuffles is the persistent white or blood-tinged nasal discharge of early congenital syphilis, appearing in the first weeks of life. The mucus contains live treponemes and is highly infectious. It results from treponemal infection of the nasal mucosa and resolves over 1-2 weeks of penicillin treatment.
Does Medicaid cover congenital syphilis treatment?▾▴
Yes. Medicaid covers congenital syphilis evaluation, hospital admission, intravenous penicillin, and long-term follow-up in every US state. Public health departments cover testing and treatment for uninsured patients. Maternal prenatal screening is universally covered as a preventive service under the ACA.
05Painful pseudoparalysis of Parrot — the infant refuses to move an arm or leg due to syphilitic osteochondritis at the metaphysis, sometimes mistaken for fracture or birth trauma.
06Periostitis and metaphyseal lucencies on long-bone radiographs (Wegner sign, Wimberger sign), present in 60-80% of symptomatic newborns.
07Failure to thrive, irritability, and low birth weight — nonspecific but common in symptomatic infants.
08Hutchinson triad in late congenital syphilis: peg-shaped notched upper central incisors, interstitial keratitis, and eighth-nerve sensorineural deafness — usually manifest between ages 5 and 15.
09Bony stigmata: frontal bossing of the skull, saddle nose deformity, saber shin (anterior bowing of the tibia), and Higoumenakis sign (sternoclavicular thickening).
10Asymptomatic neurosyphilis in the newborn — detected only by CSF abnormalities (elevated white cells, protein, reactive VDRL); progresses to late neurosyphilis without treatment.
early warning signs
•Maternal syphilis diagnosis at any point in pregnancy — newborn evaluation is required regardless of maternal treatment status
•Maternal RPR titer that has not declined fourfold despite documented treatment, especially if treatment was within 30 days of delivery
•Newborn with persistent rhinitis ("snuffles"), hepatosplenomegaly, jaundice, or rash in the first month of life
•Newborn with refusal to move an extremity (pseudoparalysis of Parrot) — examine immediately for metaphyseal periostitis
•School-age child with notched permanent incisors, hearing loss, or eye inflammation — late congenital syphilis warrants RPR and treponemal testing
● emergency signs
•Newborn with hydrops fetalis, severe pallor, or respiratory distress in the first hours of life — possible severe early congenital syphilis or hepatic failure
•Stillbirth at any gestational age — placenta and fetal tissue should be sent for treponemal testing to inform future pregnancy planning
•Newborn with seizures, bulging fontanelle, or focal neurologic signs — possible neurosyphilis requiring lumbar puncture and intravenous penicillin
•Severe purulent eye discharge in a newborn — distinguish ophthalmia from neonatal syphilitic chorioretinitis or interstitial keratitis
•Bilateral lower-extremity refusal to move with metaphyseal lucencies on X-ray — pseudoparalysis of Parrot, treat as urgent congenital syphilis
An infant titer fourfold higher than the mother's strongly suggests infection. Identical or lower titers may reflect passive maternal antibody transfer that fades over 3-6 months without treatment.
03
Infant lumbar puncture with CSF analysisDetects neurosyphilis through CSF VDRL, elevated white cell count, and elevated protein. Required for symptomatic infants and any infant whose treatment will follow the neurosyphilis regimen.
04
Long-bone radiographsIdentifies metaphyseal lucencies, periostitis, Wimberger sign (medial tibial erosion), and Wegner sign (zone of provisional calcification). Present in 60-80% of symptomatic early congenital syphilis.
05
Complete blood count, liver function, urinalysisDetects hemolytic anemia, thrombocytopenia, elevated transaminases, and direct hyperbilirubinemia common in early congenital syphilis.
06
Placental histopathology and umbilical cord examinationShows enlarged pale placenta, necrotizing funisitis, and treponemes on silver stain or PCR. Particularly valuable in stillbirth or fetal demise.
07
Ophthalmologic and audiologic evaluationDetects chorioretinitis, interstitial keratitis (often delayed onset), and sensorineural hearing loss — features that can be silent at birth.
08
Dark-field microscopy or PCR of lesion exudateDirect demonstration of T. pallidum from a moist skin or mucosal lesion, placenta, or umbilical cord. Provides definitive diagnosis in confirmed cases.
Outlook
With timely identification and full penicillin treatment, prognosis is excellent — over 95% of treated infants achieve serologic cure, and asymptomatic infants typically have no long-term sequelae. Symptomatic newborns with hepatosplenomegaly, rash, and bony lesions respond clinically within weeks, with lab abnormalities normalizing over 3-6 months. The dominant determinants of long-term outcome are how early treatment is started and the extent of existing organ damage at presentation: hearing loss from eighth-nerve involvement is partly reversible if treated within weeks of onset but irreversible if longstanding; interstitial keratitis can be controlled with topical steroids and treatment of active syphilis but corneal scarring may persist; neurodevelopmental delay correlates with extent of antenatal CNS infection and is mitigated but not eliminated by treatment. Stillbirth and neonatal death remain the worst outcomes — 8-15% of US 2022 cases in CDC data. Late congenital syphilis stigmata (Hutchinson teeth, saddle nose, saber shin, frontal bossing) are structural and do not regress with treatment, though they no longer progress. Reinfection of the child later in life is possible if behavioral risk factors emerge in adolescence or adulthood.
The dominant risk factor. Treatment more than 30 days before delivery essentially eliminates congenital infection; later treatment is increasingly inadequate.
Late or no prenatal caremodifiable
Prenatal care initiated after 20 weeks substantially raises congenital syphilis risk by missing first-trimester screening. Over 40% of US 2022 cases had inadequate prenatal care.
Maternal methamphetamine, heroin, or cocaine use in pregnancymodifiable
Substance use during pregnancy is linked to over 30% of US congenital syphilis cases. Drug use complicates engagement with prenatal care and is associated with higher reinfection rates.
Maternal HIV infectionnon-modifiable
Co-infected mothers have higher treponemal loads, more aggressive serologic relapse, and increased transmission risk; pediatric ID consult is essential.
Geographic and racial disparities in healthcare accessenvironmental
American Indian/Alaska Native infants have rates ~9x the US average; Black infants ~5x. Underlying drivers include healthcare access, structural racism, and prenatal screening uptake.
Maternal incarceration or housing instabilityenvironmental
Both interrupt continuity of prenatal care and partner notification. Outreach screening programs and jail-based testing reduce missed cases.
Sexual partner with untreated syphilismodifiable
Partner non-treatment is a leading driver of maternal reinfection. CDC recommends presumptive treatment of all sexual contacts within 90 days of maternal diagnosis.
foods to avoid
•Calcium-rich infant formula within 2 hours of oral antibiotic dosing if alternative regimens are used (rare in this age group)
07Late neurosyphilis presenting as juvenile general paresis or tabes — rare in the antibiotic era but documented
03Attend annual ophthalmology and audiology screening through age 12 to detect delayed-onset interstitial keratitis or sensorineural deafness
04Ensure all caregivers in close contact have been screened for syphilis themselves
05Maintain a continuous medical record from delivery through adolescence to coordinate long-term follow-up
Exercise
No specific restrictions. Developmental motor milestones should be tracked closely in the first 2 years to identify any delay related to early congenital syphilis or its treatment.