FIGURE 2 : Radiograph of the Femur Revealing Periosteal Elevation ( arrows ). of an affected extremity . 10 Radiographic features of periostitis show irregular areas of increased density and rarefaction along with metaphyseal serration . It is usually bilateral and symmetric and most frequently seen in the femur , humerus , and / or tibia . This bilateral metaphyseal destruction of the medial proximal tibias is a pathognomonic sign of congenital syphilis called Wimberger sign . 11 Hematologic abnormalities like anemia , thrombocytopenia , and leukopenia or leukocytosis may often be noted .
2020 . In this report , the congenital syphilis rate was 57.3 cases per 100,000 live births . 1 Cases have continued to rise since 2020 with surveillance ongoing . 1 There has been an increased rate of syphilis in women who have substance use disorder , especially when involving methamphetamines , injection drugs , or heroin . 2
Congenital syphilis is a spirochetal infection transmitted from an infected mother to her fetus during pregnancy . According to the CDC , cases of congenital syphilis require one of the following two criteria : 1 ) physical , laboratory , and / or radiographic signs of syphilitic infection or 2 ) the child is born to an untreated , inadequately , or suboptimally treated mother diagnosed with syphilis . 3
Humans are the only natural hosts of Treponema pallidum ( T . pallidum ). 4 Congenital syphilis can be caused by transplacental transmission or through direct contact with a lesion during birth . 5 Breast milk is not a source of infection unless the mother has an infectious lesion on her breast . When T . pallidum is released into circulation it leads to spirochetemia , causing dissemination of the organism to multiple organs . The inflammatory response to spirochetemia leads to the clinical manifestations seen in children .
Early congenital syphilis occurs before
the child is 2 years old . If left untreated , the clinical manifestations are apparent as early as 5 weeks with most being seen by 3 months of age . 6 The determining factors in congenital infection include the time at which the intrauterine infection occurs and when maternal treatment takes place . 7 Hepatomegaly , jaundice , rash , nasal discharge , generalized lymphadenopathy , and skeletal abnormalities are the most common clinical findings in the symptomatic infants . The rash may be maculopapular or vesicular in nature and is usually followed one or two weeks after an episode of rhinitis ( often referred to as “ snuffles ”). Other uncommon manifestations of congenital syphilis may include fever , pneumonia , failure to move an extremity , sepsis , gastrointestinal manifestations , nephrotic syndrome , and / or ophthalmologic manifestations . 7 Congenital syphilis can cause central nervous system ( CNS ) symptoms . However , progression to neurosyphilis is extremely uncommon since the advent of penicillin therapy .
In infants born to untreated mothers , abnormal long bone radiographs may be the sole sign of infection . 8 , 9 It is not uncommon to see these abnormalities with a pathologic fracture . “ Pseudoparalysis of Parrot ” or pain limiting the movement of an extremity can be seen in infants and mistaken for true paralysis
Late congenital syphilis occurs when clinical manifestations do not present until after 2 years of age . Manifestations of late congenital syphilis are multi-system and can include the following : facial abnormalities such as frontal bossing or saddle nose ; neurological involvement , including sensorineural hearing loss , cranial nerve palsies , and hydrocephalus ; interstitial keratitis ; and bone involvement with Hutchison teeth , anterior bowing of the shin , or painless arthritis of the knee (“ Clutton joints ”). 12 The specific manifestation for late congenital syphilis are Hutchison triad , mulberry molars , and Clutton joints . 12 Hutchison triad includes Hutchison teeth , interstitial keratitis , and hearing loss , which is most often sensorineural .
Absence of a proper method to culture T . pallidum makes it complicated to diagnose congenital syphilis . However , dark field microscopy or fluorescent antibody staining of the placenta , umbilical cord , or any other infected body fluids can help in direct visualization of T . pallidum , which can aid in making the diagnosis . Syphilis screening during pregnancy is recommended as recognition and treatment of maternal syphilis infections are beneficial for maternal and child outcomes . 13 Screening for syphilis should occur for all women at the initial prenatal visit . Rescreening all women routinely is not cost-effective . However , the CDC recommends repeat surveillance screening at 28 to 32 weeks of gestation and at delivery for women at high risk of acquiring syphilis during pregnancy . 14 Women who have not been screened in pregnancy should be screened at delivery . The highrisk category group include any of the
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