Cutaneous manifestations in infants evaluated for congenital syphilis: A 10-year retrospective study
Piyadarat Asawasakulchokedee, Leelawadee Techasatian, Nattakarn Tantawarak, Pongsatorn Paopongsawan, Rattapon Uppala, Phanthila Sitthikarnkha, Suchaorn Saengnipanthkul, Prapassara Sirikarn, Pope KosalaraksaBackground
Congenital syphilis remains a preventable cause of neonatal morbidity and mortality despite effective antenatal screening and treatment. Cutaneous manifestations are among the earliest recognizable clinical signs and may facilitate prompt diagnosis. This study evaluated maternal and neonatal factors associated with cutaneous manifestations among infants evaluated for congenital syphilis.
Methods
A retrospective cross-sectional study was conducted at a tertiary care center in Thailand from 1 July 2015 to 30 June 2025. Infants evaluated for congenital syphilis were identified from electronic medical records and classified according to the Centers for Disease Control and Prevention congenital syphilis evaluation framework. Maternal treatment was categorized as adequate, inadequate, or none. Demographic, maternal, and neonatal characteristics were compared between infants with and without cutaneous manifestations. Associations were assessed using Firth’s penalized logistic regression.
Results
Fifty-two infants were included, of whom 11 (21.2%) had cutaneous manifestations. Infants with and without cutaneous manifestations did not differ significantly in sex, birthweight, gestational age, or major neonatal clinical findings. Mothers of infants with cutaneous manifestations were younger, although the difference was not statistically significant (21.3 ± 4.6 vs. 23.3 ± 3.7 years, p = 0.220). Adequate maternal treatment was significantly less frequent among infants with cutaneous manifestations (18.2% vs. 69.2%, p = 0.010). In Firth’s regression analysis, adequate maternal treatment was associated with lower odds of cutaneous manifestations compared with no treatment (OR, 0.16; 95% CI, 0.03–0.91; p = 0.028). Maternal age <20 years showed a nonsignificant association with increased odds of cutaneous manifestations (OR, 3.85; 95% CI, 0.84–17.74; p = 0.083).
Conclusions
Cutaneous manifestations, which may provide an important clinical clue to congenital syphilis, were documented in approximately one-fifth of infants undergoing evaluation for the condition. Adequate maternal treatment was associated with lower odds of cutaneous manifestations. These findings highlight the clinical importance of recognizing cutaneous manifestations during the evaluation of infants at risk for congenital syphilis.