A neonate born to a mother with primary syphilis during third trimester has a reactive VDRL. On examination: snuffles (bloody nasal discharge), diffuse maculopapular rash involving palms and soles, and hepatosplenomegaly. Bone X-rays show Wimberger's sign. The correct treatment is:

• A Benzathine penicillin G 50,000 U/kg IM single dose
• B Procaine penicillin G 50,000 U/kg IM once daily for 10 days
• C Aqueous crystalline penicillin G 50,000 U/kg IV every 12 hours for 10 days ✓
• D Ceftriaxone 50 mg/kg IV daily for 14 days

Explanation

Symptomatic congenital syphilis with systemic involvement (hepatosplenomegaly, rash, bone lesions) requires aqueous crystalline penicillin G IV for 10 days — the regimen that achieves reliable CNS treponema levels. Wimberger's sign (symmetrical metaphyseal destruction at medial proximal tibia) is pathognomonic of congenital syphilis osteitis. Benzathine penicillin IM single dose is inadequate for symptomatic disease as it does not reliably penetrate the CNS. Procaine penicillin IM is an alternative only for asymptomatic neonates when compliance with the full IV course cannot be assured. Ceftriaxone is not first-line.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.