Alternate Names: Congenital lues; Fetal syphilis

Causes and Risks:

Expectant mothers who have syphilis can transmit the disease through the placenta to the unborn infant. Nearly half of all infants infected with syphilis during gestation die shortly before or after birth.

Infants who survive develop early-stage and late-stage syphilis symptoms. Early-stage symptoms include irritability, failure to thrive, and nonspecific fever. Some infants develop a rash and lesions (sores) on the borders of the mouth, anus, and genitalia (called condyloma lata).

Some of these lesions may resemble the wart-like lesions of adult syphilis. A small percentage of infants have a bloody nasal discharge (snuffles) and a saddle nose. Bone lesions are common, especially in the upper arm (humerus).

Later signs appear as tooth abnormalities (Hutchinson teeth), bone changes (saber shins), neurological involvement, blindness, and deafness. Increasing rates of syphilis in the United States have increased the number of infants born with congenital syphilis.

Prevention: Safer sexual practices can help to prevent the mother from obtaining syphilis. Uninfected mothers cannot give syphilis to their unborn infant. Infected mothers should be treated as soon as they are diagnosed.

Prenatal care for expectant mothers is a necessity. During prenatal care evaluations a routine serologic test for syphilis is done. This identifies infected mothers and allows them to be treated before any harm comes to the baby.

Symptoms: NEWBORN

• Irritability
• Failure to gain weight or failure to thrive
• Bloody discharge from the nose
• Early rash
  • Small blisters (vesicles) on the palms and soles
• Later rash
  • Copper-colored, flat or bumpy (maculopapular) rash on the face, palms, soles
• Rash at the junction of the skin and mucus membranes of the mouth, genitalia, and anus
• No bridge to nose (saddle nose)

• Bone pain
• Refusal to move a painful extremity
• Saber shins (bone abnormality of the lower leg)
• Joint swelling (joint effusion)
• Abnormal teeth (notched and peg shaped--called Hutchinson teeth)
• Scarring of the skin around earlier lesions on the mouth, genitalia and anus (called rhagades)
• Visual loss
• Clouding of the cornea
• Decreased hearing or deafness
• Gray, mucous-like patches on the anus and vulva (condyloma lata)

Signs and Tests:

The physical examination may show signs of periostitis or osteochondritis (both of these are types of bone inflammation). There may be evidence of hepatomegaly (enlarged liver) and splenomegaly (enlarged spleen).

Tests:

• On the mother may include:
  
• VDRL
• FTA-ABS fluorescent treponemal antibody test

If the disorder is suspected at the time of birth, the placenta will be examined for signs of syphilis.

• On an older infant or child may include:
  
• Serologic test for syphilis (VDRL and FTA-ABS)
• Microscopy, dark field examination (demonstrates T. pallidum)
• X-ray of the bone(s)

Treatment: Penicillin is the treatment for all forms of syphilis. Infants born to infected mothers who received adequate penicillin treatment during pregnancy are at minimal risk.

Prognosis: A high death rate is typical of congenital syphilis. Treatment of the expectant mother prevents congenital syphilis in the infant.

Complications:

• Blindness
• Deafness
• Facial deformity
• Neurological abnormalities

Call your health care provider if your baby has signs or symptoms as described in this document.

If you suspect that you may be infected with syphilis and are pregnant (or anticipate becoming pregnant), call your health care provider immediately.