The objective of this study was to evaluate surveillance data and desc
ribe characteristics of cases of congenital syphilis. A retrospective
case review of notifications of congenital syphilis in infants one yea
r of age and less from January to December 1991, in a rural region of
New South Wales (NSW), was conducted. The Centres for Disease Control
(CDC) and other case definitions for congenital syphilis were used as
the Main Outcome Measure. Results showed thirteen notifications made t
o the public health unit of the region during the study period. On che
cking, two notifications turned out to be in adult women and two babie
s had been notified twice. This left nine babies, of whom five fulfill
ed the CDC criteria for presumptive congenital syphilis. Under the cur
rent national case definition, none would have been classed as congeni
tal syphilis. The findings reveal significant problems with the notifi
cation of early congenital syphilis in NSW, to the extent that reporte
d rates may be substantially higher than true rates. Nevertheless, the
re is a need to continue to make antenatal diagnosis and treatment of
syphilis a high priority in populations at risk.