Function

With early congenital syphilis, systemic symptoms are common and include jaundice, fever, edema, and low birth weight. 

Function

Jaundice caused by hyperbilirubinemia is a common abnormality with early congenital syphilis, and it can result from syphilitic hepatitis and/or hemolysis.

Function

In newborns, temperature is usually taken with a rectal thermometer. A rectal temperature of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher is considered a fever. Fever tends to be more pronounced in infants with congenital syphilis when maternal infection occurs late in pregnancy.

Function

Infants with congenital syphilis who develop nephrotic syndrome typically present at 1–2 months of age with generalized edema (anasarca). In addition, localized edema may occur in association with inflammatory lesions.

Function

Low birth weight (less than 5 pounds 8 ounces [2,500 grams] is one of the most common features with early congenital syphilis.

Function

Rhinitis is a common manifestation of early congenital syphilis that manifests in the first week of life. The rhinitis (nasal discharge) is typically heavy and intractable. The nasal fluid contains abundant spirochetes. This manifestation is also commonly referred to as “snuffles”. The congenital syphilis snuffles manifestation was first described by Michael Underwood and Henry Maunsell in 1789.
 

Function

This image shows normal infant lungs without evidence of pneumonia. The inset shows expanded normal right lung.


 

Function

Pneumonia alba is a process where the newborn alveolar septa become diffusely inflamed and fibrotic in response to Treponema pallidum pulmonary infection. The lungs take on a pale, gray-white appearance. The inset shows an expanded view of pneumonia alba (right lung).

Function

Dermatologic manifestations are very common with early congenital syphilis, occurring in approximately 60-70% of infants with symptomatic congenital syphilis. The congenital syphilis-associated skin abnormalities are often present at birth or very early in life.  

Function

A diffuse maculopapular rash is common with congenital syphilis, and it usually appears 1–2 weeks after rhinitis; it is characterized by oval pink lesions that gradually become more reddish-brown or rust-colored. The rash is often most prominent on the chest, back, palms, and soles. The skin lesions contain abundant spirochetes.
 

Function

Bullous lesions are a cutaneous manifestation of congenital syphilis and most often involve the hands and/or feet, but less often they can be more generalized. The bullous lesions, which are referred to as syphilitic pemphigus (or pemphigus syphiliticus), are characterized by large fluid-filled blisters that are fragile and typically rapidly evolve with desquamation and erosions. This manifestation, when present, typically occurs in the first few weeks of life and may even be present at birth.

Function

Condylomata lata are painless, moist, plaque-like, that moist often develop in warm and moist regions of the body (e.g., inner thighs, perianal, axillae, and skin folds). These lesions are typically teeming with spirochetes.
 

Function

This illustration shows normal infant eyes. There are a number of ophthalmic abnormalities that can develop with syphilis, including cataracts, glaucoma, uveitis, keratitis, iritis, chorioretinitis, and optic neuritis. The following will focus on two common abnormalities: cataracts and uveitis. These abnormalities are often relatively easy to detect on a physical examination.

Function

Ophthalmologic complications with congenital syphilis can include cataract formation, which appears as an opaque or gray discoloration in the lens of the eye (as shown here in the infant’s right eye). This ocular manifestation would likely cause cloudiness in the infant’s vision. The cataract caused by congenital syphilis can be present at birth or develop early in life.

Function

This illustration shows uveitis, an ophthalmic manifestation of congenital syphilis. Infection in the uvea, which includes the iris, ciliary body, and choroid. Uveitis most often manifests as eye pain and unilateral eye redness (as shown here for the infant’s right eye). There are three types of uveitis depending on the region of the uvea involved: anterior uveitis (iritis), intermediate uveitis, posterior, or panuveitis.

Function

Some infants with congenital syphilis may have multiple ocular abnormalities, as shown here with both cataract (white opaque area on lens of the right eye) and uveitis (diffuse redness in the right eye). If both of these manifestations are present, the infant would likely have a significant decrease in vision.

Function

This image shows the typical appearance and size of the liver and spleen in a healthy newborn.

Function

Hepatomegaly is a common abnormality with congenital syphilis. This is often detected on fetal ultrasound. Hepatomegaly may occur with or without splenomegaly. In this image, the infant does not have splenomegaly.

Function

Among infants with congenital syphilis who have hepatomegaly, approximately 50% also have splenomegaly. Isolated splenomegaly typically does not occur.

Function

Abnormalities of the long bones occur in 60-80% of cases of untreated congenital syphilis. The bone manifestations are usually bilateral and include metaphyseal changes, bone destruction, periosteal inflammation, and pseudoparalysis.

Function

The illustration shows inflammation of the distal metaphysis of the femur and destruction of the medial metaphysis of the proximal left tibia. Bilateral proximal medial metaphyseal tibial bone destruction with congenital syphilis was originally described by Hans Wimberger in 1925 and this finding is referred to as Wimberger’s sign.
 

Function

The illustration shows periosteal inflammation of the proximal left tibia (arrow). These lesions may be associated with significant pain. Periostitis usually involves multiple regions of the metaphyses of long bones (inset) and abnormal long bone radiographic findings are nearly always present.
 

Function

Infants with congenital syphilis and periostitis may experience pain and limited movement of the affected limbs. If the periostitis is severe, the infant may entirely avoid moving the affected limb and this condition can be mistaken for paralysis, hence the term "pseudoparalysis". This was originally described by Joseph Marie Jules Parrot in 1871 and the condition is commonly referred to as Pseudoparalysis of Parrot. Typically, the upper limbs are affected, with bilateral involvement. The infant clinically presents with the upper extremities hanging flaccid and extended along the side of the body.
 

Function

Non-tender lymphadenopathy is a common manifestation of early congenital syphilis. Lymphadenopathy associated with congenital syphilis is usually generalized and nontender. The lymphadenopathy develops in response to Treponema pallidum infection in the lymph nodes. The most common areas of involvement are the neck, axillae, and groin.
 

Function

Central nervous system infection with Treponema pallidum is common among infants with confirmed congenital syphilis. There are an array of neurologic manifestations that can occur with early congenital syphilis, including syphilitic leptomeningitis, meningoencephalitis, cranial nerve palsies, seizures, sensorineural hearing loss, and hydrocephalus.