Congenital syphilis is syphilis present in utero and at birth, and occurs when a child is born to a mother with syphilis. Untreated early syphilis infections results in a high risk of poor pregnancy outcomes, including saddle nose, lower extremity abnormalities, miscarriages, premature births, stillbirths, or death in newborns. Some infants with congenital syphilis have symptoms at birth, but many develop symptoms later. Babies exposed in utero can have deformities, delays in development, or seizures along with many other problems such as rash, fever, an enlarged liver and spleen, anemia, and jaundice. Newborns will typically not develop a primary syphilitic chancre, but may present with signs of secondary syphilis. Often these babies will develop syphilitic rhinitis, the mucus from which is laden with the T. pallidum bacterium, and therefore highly infectious. Rarely, the symptoms of syphilis go unseen in infants so that they develop the symptoms of latent syphilis, including damage to their bones, teeth, eyes, ears, and brain.
Classification
Early
This is a subset of cases of congenital syphilis. Newborns may be asymptomatic and are only identified on routine prenatal screening. If not identified and treated, these newborns develop poor feeding and runny nose. By definition, early congenital syphilis occurs in children between 0 and 2 years old. After, they can develop late congenital syphilis. Symptomatic newborns, if not stillborn, are born premature, with an enlarged liver and spleen, skeletal abnormalities, pneumonia and a bullous skin disease known as pemphigus syphiliticus.
Late
Late congenital syphilis is a subset of cases of congenital syphilis. By definition, it occurs in children at or greater than 2 years of age who acquired the infection trans-placentally. Symptoms include:
Blunted upper incisor teeth known as Hutchinson's teeth¨
A frequently-found group of symptoms is Hutchinson's triad, which consists of Hutchinson's teeth, keratitis and deafness and occurs in 63% of cases. Treatment before the development of late symptoms is essential.
Higouménakis' sign, enlargement of the sternal end of clavicle in late congenital syphilis
Hutchinson's triad, a set of symptoms consisting of deafness, Hutchinson's teeth, and interstitial keratitis, an inflammation of the cornea which can lead to corneal scarring and potential blindness
Rhagades, linear scars at the angles of the mouth and nose result from bacterial infection of skin lesions
Snuffles, aka "syphilitic rhinitis", which appears similar to the rhinitis of the common cold, except it is more severe, lasts longer, often involves bloody rhinorrhea, and is often associated with laryngitis
Serological testing is carried out on the mother and the infant. If the neonatal IgG antibody titres are significantly higher than the mother's, then congenital syphilis can be confirmed. Specific IgM in the infant is another method of confirmation. CSF pleocytosis, raised CSF protein level and positive CSF serology suggest neurosyphilis.
Treatment
If a pregnant mother is identified as being infected with syphilis, treatment can effectively prevent congenital syphilis from developing in the fetus, especially if she is treated before the sixteenth week of pregnancy. The fetus is at greatest risk of contracting syphilis when the mother is in the early stages of infection, but the disease can be passed at any point during pregnancy, even during delivery. A woman in the secondary stage of syphilis decreases her fetus's risk of developing congenital syphilis by 98% if she receives treatment before the last month of pregnancy. An affected child can be treated using antibiotics much like an adult; however, any developmental symptoms are likely to be permanent.citation needed
