707. Congenital Syphilis: Management Dilemmas using Reverse Screening
Session: Poster Abstract Session: They've Been Here a Billion Years! Pediatric Bacterial and Viral Infections
Thursday, October 27, 2016
Room: Poster Hall
  • Congenital Syphilis Algorithm.pdf (1.7 MB)
  • Congenital Syphilis: Management Dilemmas using “Reverse Screening”


    Background: Although not recommended by the American Academy of Pediatrics (AAP) for pregnant women, some laboratories are using “reverse screening (RS)” for the serologic screening for syphilis. This method of testing starts with a treponemal specific enzyme immunoassay (EIA) or chemiluminescence immunoassay (CIA) screening test followed by a nontreponemal test (i.e. RPR) if the EIA or CIA is positive. Discordant treponemal and nontreponemal results may occur, prompting the need for a “tie-breaker” treponemal test such as a Treponema pallidum particle agglutination assay (TPPA).

    RS may identify mothers with no history of syphilis or syphilis treatment but with a reactive treponemal test and a nonreactive nontreponemal test. Such discordant results have resulted in uncertainty in management of the neonate, creating maternal serologic scenarios for which there are currently no guidelines or algorithms to guide the evaluation and management of these neonates. The AAP provides no guidance for neonates born to mothers with discordant results using reverse screening. The Centers for Disease Control (CDC) provides some guidance in the evaluation of suspected congenital syphilis (CS), but they are not specific to RS.

    Methods: We reviewed the literature for RS in pregnant women and developed a draft algorithm for management of neonates. We posed clinical scenarios to specialists with extensive pediatric syphilis experience.  The proposed algorithm is a conservative approach to the management of these infants and reflects a synthesis of approaches, but the final algorithm may not reflect the approach of each contributing author.

    Results: We propose the following algorithm for the management of neonates born to mothers with discordant serology using RS.

    Conclusion: Current AAP and CDC guidelines for CS are not tailored to reverse screening. Evidence-based data for evaluating these neonates is limited. We have developed a conservative proposed algorithm for the management of neonates born to mothers with discordant serology using RS.


    Michelle Sewnarine, MD, Pediatric Infectious Diseases, Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, NY, Sujatha Rajan, MD, Steven and Alexandra Cohen Children's Medical Center of New York of the North Shore-Long Island Jewish Health System, New Hyde Park, NY, Geoffrey Weinberg, MD, FIDSA, FPIDS, Pediatrics, Univ. of Rochester Sch. of Med. and Dent., Rochester, NY, Kenneth Bromberg, MD, FIDSA, FPIDS, Brooklyn Hospital Center, Brooklyn, NY, Sunil Sood, MD, FIDSA, Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, NY and Lorry Rubin, MD, FIDSA, Pediatrics, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY


    M. Sewnarine, None

    S. Rajan, None

    G. Weinberg, None

    K. Bromberg, None

    S. Sood, None

    L. Rubin, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.