Table 4. Transplacental infections: treatment.

	Cytomegalovirus	Parvovirus B19	Toxoplasmosis	Syphilis
•Treatment during pregnancy	Valaciclovi r to prevent mother-to-child transmission in cases of primary infection around the time of conception or during the first trimester (experimental treatment) until amniocentesis	•In cases of severe fetal anemia or hydrops fetalis → intrauterine transfusion	•Before the 16th week of gestation, spiramycin; from the 16th week of gestation, PSF for at least 4 weeks	•Benzathine benzylpenicillin IM (regimen depends on the stage of infection); in the presence of HIV, neurosyphilis or abnormal findings on ultrasound → refer to a pediatric infectious disease center
•Treatment of neonates with congenital infection	Symptomatic cCMV: valganciclovir for 6 months If hearing test is abnormal but no other symptoms are present: consider 6 weeks of therapy In severely ill newborns, initial treatment with intravenous ganciclovir may be necessary	•In cases of persistent hyporegenerative anemia, treatment with immunoglobulins may be tried	•For symptomatic neonates, PSF for 12 months is recommended; in cases of high cerebrospinal fluid protein levels (≥ 1,000 mg/dL) or active retinochoroiditis threatening vision, steroids are indicated as well; for infected, asymptomatic neonates, there is no standard approach (no treatment vs. 3 months of treatment)	•Penicillin G intravenously for 10–14 days

cCMV, congenital CMV infection; HIV, human immunodeficiency virus; IM, intramuscular; IV, intravenous; PSF, pyrimethamine/sulfadiazine with folinic acid