The Comparative Value of the Serologic and Roentgenologic Diagnoses of Congenital Syphilis

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The time to diagnose congenital syphilis is immediately after birth, hence the importance of the development of accurate methods which will establish beyond a question of doubt the presence of syphilitic infection in the newborn. The clinical aspects of syphilis have changed considerably in the last 25 years. It is rare that one encounters in hospital practice fully developed, clinical syphilis. The general rule is that there is very little clinical indication of syphilis. Furthermore, clinicians rarely make exhaustive searches for the presence of syphilis. The great majority rely upon the examination of the blood or spinal fluid, or both. In congenital syphilis, unless one is aware that the mother has syphilis, and unless definite evidence of syphilis is present in the newborn, such as skin lesions, etc., the detection of syphilis has, up to recent times, depended entirely upon examination of the blood. Lately, the roentgenologic diagnosis of syphilitic involvement of the osseous system has been developed to a high degree of accuracy. The diagnosis of congenital syphilis by serologic methods applied to the cord blood has had varying degrees of success, and there is a general opinion among many obstetricians that the examination of the cord blood is not very accurate. It is important to emphasize now that, in reviewing the literature, one must pay careful attention to the methods employed for the serologic diagnosis of syphilis. In Mount Sinai Hospital, a complement fixation test, the Kahn test, and Kline's micro-precipitation test have been used routinely. A description of the technic and the results obtained on cases other than obstetric has been reported from this laboratory (1). The same tests were applied to maternal blood and blood obtained from the cord at delivery. In a few cases, blood was taken from the fontanel. In all instances of positive serology, re-checks were made on blood obtained from the fontanel. Cord blood is very apt to be antecomplementary, according to Kolmer (2), yet in about one thousand examinations we have had no antecomplementary reactions, and we attribute this to the technic used in obtaining the blood. As soon as the child has been delivered, the cord is wiped dry with a sterile sponge, cut through with sterile scissors which have not been used for any other purpose during the course of the delivery, and the blood allowed to drip freely into a test tube. The tube is immediately corked and sent to the laboratory. We feel that, if the tests are carried out properly—and it must be remembered that these tests for syphilis are highly technical and must be done with great care—the results have a very high degree of accuracy. Furthermore, it is our opinion that, if similar tests serve to diagnose acquired syphilis without clinical manifestations, they should be equally applicable to the blood of mothers and newborn infants.