Syphilis is transmitted from the mother to the fetus via the placenta after end of the 4th mo when the placenta is fully formed. Congenital syphilis is pre- ventable and occurs only in untreated pregnant women. If routine prenatal STS are carried out on all pregnant women, the incidence of congenital syphilis can be greatly reduced. The more recent the infection in the mother, the greater the risk of congenital syphilis in the fetus. In untreated mothers with late syphilis, a healthy child may be born between two others who have congenital syphilis.

Symptoms and Signs

    In early congenital syphilis skin lesions are found on the infant. Bullous erup- tions on the palms of the hands and soles of the feet, and papular lesions around the nose and mouth and in the diaper area are the most characteristic. A general- ized lymphadenopathy is also present. The infant may fail to thrive, have a char- acteristic "old man" look, develop fissured lesions around the mouth (rhagades), have a mucopurulent or blood-stained nasal discharge causing snuffles, and have an enlarged liver or spleen. A few infants may develop meningitis, choroiditis, hydrocephalus or convulsions, and others may be mentally retarded. Within the first 3 mo of life, osteochondritis (chondroepiphysitis) may result in pseudoparal- ysis of the limbs with characteristic radiologic changes in the bones.
       Many patients with congenital syphilis remain in the latent stage of the disease throughout their lives and never present any active manifestations. In others, late stigmas appear. Gummatous ulcers tend to involve the nose, septum, and hard palate, while periosteal lesions result in "saber shins" and bossing of the frontal and parietal bones. Neurosyphilis may be meningovascular in type, but juvenile paresis and tabes may develop. Optic atrophy, sometimes leading to blindness, may occur. Interstitial keratitis is the commonest eye lesion and frequently re- lapses, often resulting in scarring of the cornea. Perceptive deafness, which is often progressive, may appear at any age. Hutchinson's incisors, Moon's molars, and maldevelopment of the maxilla resulting in "bulldog" facies are frequently present.

Diagnosis

    Late congenital syphilis is diagnosed by the clinical history, distinctive physical signs, and positive seralogic tests. Hutchinson's triad of interstitial keratitis, Hutchinson’s incisors, and 8th nerve deafness is diagnostic. Sometimes the stan- dard serologiz tests are negative and the TPI test may also be negative, but the FTA-ABS is usually positive. The diagnosis should be considered in cases of unexplained deafness.

— ed. Robert Berkow, The Merck Manual of Diagnosis and Therapy, pp.1761-2

It is as worthy of consideration, as it is consistent with scientific truth, to suppose that the four deceased children represented, on the part of the mother, a condition of exhausted vital power. She had not bestowed upon their constitutions a strength which she had not to spare. They therefore died

— Joseph Stapleton, The Great Crime of 1860, pp.25-6