Congenital syphilis occurs when the syphilis spirochete infects a fetus in utero. Without treatment, approximately 25% of infants with congenital syphilis will die either during pregnancy or shortly after birth. Manifestations of congenital syphilis are divided into infantile forms that occur in the first two years of life, and tardive forms that occur later. Common infantile symptoms include nasal discharge, rashes, liver and bone abnormalities. Late or tardive syphilis develops in nearly half of untreated infants and can cause facial deformities, bone abnormalities, and damage to internal organs like the liver.

2.  Congenital syphilis occurs most
frequently during maternal primary or
secondary syphilis, when the
spirochetes are most numerous.
 Intrauterine death and perinatal death
occurs in approx 25% of cases of
untreated congenital syphilis.

3.  Manifestations of congenital syphilis are
divided into two: infantile an tardive.
 Infantile – occur in the first two years of life.
 Tardive- occur later.

4.  Infantile syphilis is often manifested by nasal
discharge and congestion.
 A desquamating or bullous rash can lead to
sloughing of skin of the hands and feet and
around mouth and anus.
 Hepatomegaly and skeletal abnormalities are
common.

5.  Late or tardive syphilis develop in nearly half
of untreated children with neonatal syphilis.

6.  The rash of congenital syphilis is more severe
than that of adult secondary syphilis.
 It is a bullous eruption of the palm and soles
associated with epidermal sloughing.

7.  Syphilitic osteochondritis and periostitis
affect all bones, but lesions of nose and lower
leg are most distinctive.
 Destruction of the vomer causes collapse of
the bridge of the nose and, later on, the
saddle nose deformity.

8.  Periostitis of tibia leads to excessive new
bone growth on anterior surfaces and
anterior bowing or saber shin.
 The epiphysis become widened as the
cartilage grows, and cartilage is found in
displaced islands within the metaphysis.

9.  The liver is often severely affected in
congenital syphilis.
 Diffuse fibrosis permeates lbules to isolate
hepatic cells into small nests, accompanied
by the lymphoblastic infiltrate and vascular
changes.
 Gummas are occasionally found in liver ,even
in early cases.

10.  In the syphilitic stillborn the lungs appear
pale and airless called pneumonia alba.
 The generalized spirochetemia may lead to
diffuse interstitial inflammatory reactions in
virtually any other organ.

11.  The late manifestations include a triad of
interstitial keratitis, hutchinson teeth, and
eighth nerve deafness.
 Ocular changes also include choroiditis and
abnormal retinal pigmentation.

12.  Hutchinson teeth are small incisors shaped
like a screwdriver or a peg, often with
notches in the enamel.
 Eighth nerve deafness and optic nerve
atrophy develop secondary to
meningiovascular syphilis.

13.  YAWS – Tryponema pallidum pertenue
 PINTA – Tryponema pallidum carateum.