Clinical Manifestations and Sequelae (continued)

Congenital Syphilis

Congenital syphilis occurs when T. pallidum is transmitted from a pregnant woman with syphilis to her fetus. Untreated syphilis during pregnancy may lead to stillbirth, neonatal death, and infant disorders such as deafness, neurologic impairment, and bone deformities.

Transmission to the fetus in pregnancy can occur during any stage of syphilis, but the risk is much higher during primary and secondary syphilis. Fetal infection can occur during any trimester of pregnancy. A wide spectrum of severity exists, and only severe cases are clinically apparent at birth.

Congenital syphilis is traditionally classified as either early or late disease. Early manifestations occur within the first two years of life, and late manifestations occur after two years of age. Early manifestations are the most common.

Early lesions (in infants <2 years old):

• Are usually inflammatory.
• May involve skin (can be bullous or exudative) or mucous membranes.
• Can result in alopecia, generalized lymphadenopathy, meningitis, osteitis or osteochondritis, and hepatosplenomegaly.
• May include hematologic abnormalities such as thrombocytopenia and anemia.

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Late lesions (in children >2 years old):

• Tend to be immunologic and destructive.
• Most commonly appear as interstitial keratitis.
• Less commonly result in eighth nerve deafness, bone and teeth involvement (saber shins, mulberry molars, Hutchinson incisors).

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Page last modified: June 3, 2009 Page last reviewed: June 3, 2009 Content Source: Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention