An 80-day-old infant referred from the Pediatric Hospital and diagnosed to have Early Congenital Syphilis due to Wimberger's sign and osteochondritis of the long bones diagnosed by Roentgenogram. Wimberger's sign is a characteristic sign of Early Congenital Syphilis. In this there is loss of density in the medial aspect of upper end of tibia. There are marked irregular patches of loss of density in the bones particularly in the metaphyses.

1. Spouse escaped but infant infected

2. Letter to the Editor
Spouse escaped but infant infected
Dear Sir,
Recently we come across an interesting client. An 80-day-
old infant referred from the Pediatric Hospital and diagnosed
to have Early Congenital Syphilis due to Wimberger’s sign
(Fig. 1) and osteochondritis (Figs. 1 and 2) of the long bones
diagnosed by Roentgenogram. Wimberger’s sign is a charac-
teristic sign of Early Congenital Syphilis. In this there is loss of
density in the medial aspect of upper end of tibia (Fig. 1). There
are marked irregular patches of loss of density in the bones
particularly in the metaphyses (Figs. 1 and 2). These changes
are very characteristic of Early Congenital Syphilis.1
Mother
was having Late Latent Syphilis. Fortunately the father of the
infant was not affected.
History revealed that the mother was infected 5 years ago
and she was not treated and investigated. She got married 1
year ago and denied other contacts. She was not investigated
during the antenatal period for Syphilis.
In this client the spouse escaped because of the Late
Syphilis but the infant is infected even though she is in the
Latent Stage of Syphilis.
The baby was treated with Penicillin and improved well.
Mother and Father were also treated with Penicillin.
Latent Syphilis is defined as having serologic proof of
Syphilis without symptoms of Syphilis. It is further described
as either early (less than 1 year after secondary Syphilis) or
late (more than 1 year after secondary Syphilis) in the United
States.2
The United Kingdom uses a cut-off of two years for
early and late Latent Syphilis.3
Early Latent Syphilis may
have a relapse of symptoms. Late Latent Syphilis is usually
asymptomatic, and not as contagious as early Latent Syphilis.2
The causative agent for Syphilis Treponema pallidum cross
the placenta to infect the fetus after 18 weeks of gestation
when the Langhans cell layer has atrophied.4
A general rule
Kasowitz law is “The longer the duration of the untreated
infection before the pregnancy, the less likely it is that the fetus
will be stillborn or infected”. Hence the mother can transmit
the spirochetes even in the latent phase of Syphilis. When the
mother in the primary and secondary stages of Syphilis lead to
stillbirth whereas in the later stages of Syphilis lead to various
stages of Congenital Syphilis to an uninfected child.4
Congenital Syphilis in the newborn can be prevented by
screening mothers during early pregnancy and treating those
Fig. 1 Fig. 2
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Please cite this article in press as: Arunkumar S, et al., Spouse escaped but infant infected, Apollo Medicine (2013), http://
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3. who are infected. Hence the World Health Organization rec-
ommends all women be tested at their first antenatal visit and
again in the third trimester.5,6
We are reporting this because of we have to be more vigi-
lant to detect and prevent Congenital Syphilis and should not
avoid the VDRL test during antenatal period.
r e f e r e n c e s
1. Venereal Diseases by Ambrose King, Claude Nicol and Philip Rodin. 4th
ed. ELBS and Bailliere Tindall; Chapter 6, Congenital Syphilis, 115.
2. Bhatti MT. Optic neuropathy from viruses and spirochetes. Int
Ophthalmol Clin. 2007;47(4):37e66.
3. Eccleston K, Collins L, Higgins SP. Primary syphilis. Int J STD
AIDS. 2008 Mar;19(3):145e151.
4. Syphilis a Synopsis e by U.S. Department of Health, Education,
and Welfare, Public Health Service Publication No. 1660
January 1968, Chapter VIII Syphilis in pregnancy and
Congenital Syphilis, 86.
5. Hawkes S, Matin N, Broutet N, Low N. Effectiveness of
interventions to improve screening for syphilis in pregnancy:
a systematic review and meta-analysis. Lancet Infect Dis. 2011
Jun 15;11(9):684e691.
6. Schmid G. Economic and programmatic aspects of congenital
syphilis prevention. Bull World Health Organ. 2004 Jun;82(6):
402e409.
Subbian Arunkumar*
Department of STD, Chengalpattu Medical College, Chengalpattu,
Tamil Nadu 603001, India
V. Sudha
P.S. Mohanasundari
Institute of Venereology, Madras Medical College, Chennai,
Tamil Nadu 600003, India
*Corresponding author. Tel.: þ91 9884166648.
E-mail address: arunssshc@gmail.com
8 March 2012
Available online xxx
0976-0016/$ e see front matter
Copyright ª 2013, Indraprastha Medical Corporation Ltd. All rights
reserved.
http://dx.doi.org/10.1016/j.apme.2013.06.003
a p o l l o m e d i c i n e x x x ( 2 0 1 3 ) 1 e22
Please cite this article in press as: Arunkumar S, et al., Spouse escaped but infant infected, Apollo Medicine (2013), http://
dx.doi.org/10.1016/j.apme.2013.06.003

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