Congenital syphilis in children is rare in Britain, and most doctors will never have seen a case. The only routine data currently available are reports from genitourinary medicine clinics, the KC60 returns. In the last two years for which data are available (1991 and 1992) clinics in England reported 220 new diagnoses of infections syphilis in women (pregnant or otherwise) and five of congential syphilis in children under 2.^1,2 Women identified through antenatal screening, however, may not be treated in genitourinary medicine clinics, and some infected children may be seen only by paediatricians - so that the true incidence of both conditions is unknown.

What can be done to prevent congenital syphilis? Transmission from mother to child usually takes place after four months' gestation, so early antenatal serological screening and treatment prevent most cases. Detection later in pregnancy is less effective, but even postnatal treatment of an infected child prevents many sequelae. Tests occasionally miss maternal infection, especially if only reagin …