[Question #1765] Congenital syphilis probability

43 months ago

Hello doctor.

It’s a complex question. I’ll try to be clear:

About two years before having my first child I ended up in a party where I had vaginal sex with what was possibly a sex worker. I don’t remember if I wore a condom. I tested negative for HIV.

One year and a half after that I had my child. The baby was diagnosed with pyloric stenosis. Surgery went ok. A few months later, he got ill with vomits and little appetite for three months.

About a year later the doctor found a “very little” enlargement both in the liver and in the spleen and that the child had an accessory spleen. I saw that children with congenital syphilis can have spleen and liver enlarged. I thought it can’t be syphilis because I donated blood a few months after delivery and the blood bank tests for syphilis with treponemal tests. Besides, in Spain pregnant women are tested with the RPR test.

But two months later, my child began to suffer ear discharges often. I saw that this also happens to children with congenital syphilis. And I remembered he had had rashes a couple of times. Then I remembered that between my indiscretion and my first blood donation I had two courses of amoxicillin prescribed by an orthodontist. One before pregnancy and one after my child was born.

So, is there a chance that I first contracted syphilis, then infected my wife, then I got cured by the antibiotics and my treponemal test turned negative and, finally, the RPR tests of my wife turned false negatives and she infected the child?

Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago

Welcome to our Forum. I'll try to help.  Parents frequently worry if they are to blame when their children become sick and I suspect that the combination of your guilt over your contact out of marriage and your child's illnesses have led you to be concerned about syphilis.  I wish to reassure you that your child's illnesses are not due to syphilis but are simply unfortunate coincidences.  I say this with confidence because of the many ways that syphilis might have been detected in you or your wife (when she was tested during pregnancy) long before now.  While no test is perfect, the chance that syphilis would have be missed in you when you had no symptoms, when your blood was tested at the time of blood donation and when your wife was tested during pregnancy is zero.  Further neither pyloric stenosis nor accessory spleens are associated with syphilis and both ear discharge and splenic enlargement are non-specific findings with many causes other than syphilis.

I urge you to put your concerns about syphilis behind you and hoe that your child does well going forward.  EWH

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42 months ago

Thanks for your reassuring words. They have really made an effect. Anyway, as my main concern was the possibility of having tested negative because of the amocillin, let me ask you one further question.

Given that you didn’t even addressed the issue in your answer, can I conclude that the possibility of being cured by the amoxicillin and then having a negative treponemal test is so low as not worry about having been previously infected?

This will be my last question. Thanks for your time again.

(By the way, my child is doing just fine. Everything save the splenic enlargement is completely o)

Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago
If you had syphilis, the amoxicillin might have cured it however even so, your treponemal blood test would most likely have remained positive.  Further, had you transmitted infection to your wife, her test would have been positive.  All things considered however, there is very, very little chance that you acquired syphilis to start with.  This really is not something to worry about. (and I am glad to hear that your child is doing well).  EWH
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42 months ago
Thanks again, Doctor.

I'll try to believe the tests.

The problem is that with the adoption of the reversal algorithm there are a lot of sources on-line highlighting the lack of sensibility of the RPR test in the late latent stages of the infection. I guess that will be a major source of worry for people like me - people who has been tested about 2 - 3 years after the probable infection.

Anyway, I guess this is as good as i gets. So, thanks for your time and counsel.


Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago
There is much debate about how much active, infectious (including for causing congenital infection) Syphilis is detected using the reverse testing algorithm for syphilis.  Much of what is detected by such testing is old, treated infection.  Some is also,falsely positive tests.  I am confident you have not given your wife or daughter syphilis.

This is the third and therefore final reply to your questions.  I wish you and your family the best and hope you will soon be able to move forward.  This thread will be closed later today.  EWH
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