Congenital syphilis

[Gregory]

Congenital syphilis is a multisystem infection caused by Treponema pallidum and transmitted to the fetus via the placenta. Early signs are characteristic skin lesions, lymphadenopathy, hepatosplenomegaly, failure to thrive, blood-stained nasal discharge, perioral fissures, meningitis, choroiditis, hydrocephalus, seizures, intellectual disability, osteochondritis, and pseudoparalysis (Parrot atrophy of newborn). Later signs are gummatous ulcers, periosteal lesions, paresis, tabes, optic atrophy, interstitial keratitis, sensorineural deafness, and dental deformities. Diagnosis is clinical, confirmed by microscopy or serology. Treatment is penicillin.
(See also Syphilis in adults and Overview of Neonatal Infections.)
Overall risk of transplacental infection of the fetus is about 60 to 80%, and likelihood is increased during the 2nd half of the pregnancy. Untreated primary or secondary syphilis in the mother usually is transmitted, but latent or tertiary syphilis is transmitted in only about 20% of cases. Untreated syphilis in pregnancy is also associated with a significant risk of stillbirth and neonatal death. The rate of congenital syphilis in the US has been rising dramatically in recent years with a 185% increase from 2014 to 2018. Over 1300 cases were reported in 2018, including 78 stillbirths and 16 infant deaths (1). In infected neonates, manifestations of syphilis are classified as early congenital (ie, birth through age 2 years) and late congenital (ie, after age 2 years).