Maternal/congenital syphilis in a large tertiary-care urban hospital.

Among the women delivering a total of 9,591 infants in 1990 at Hutzel Hospital in Detroit, 148 had positive results in the rapid plasma reagin (RPR) and fluorescent treponemal antibody-absorption tests for syphilis. This group included primarily young, black, multigravid women with a history of crack cocaine use. RPR titers ranged from 1:1 to 1:256 among the 103 mothers not treated or inadequately treated for syphilis. Two mothers with very low RPR titers (1:2) delivered a stillborn infant and an infant with a reaction in the cerebrospinal fluid Venereal Disease Research Laboratory (CSF-VDRL) test, respectively. Seventy-five percent of the infants born to untreated or inadequately treated women had asymptomatic congenital syphilis. The remaining 25% were stillborn (6 infants) or had clinical features of congenital syphilis (3 infants), a reactive CSF-VDRL test (11 infants), or radiological evidence of periostitis or metaphysitis (6 infants). Abnormalities were documented in the placentas from 11 live births and one stillbirth. The resurgence of congenital syphilis highlights the need for better diagnostic tests and for studies that will determine optimal therapy for mother and infant.