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Congenital syphilis is a severe, disabling, and often life-threatening infection seen in infants. A pregnant mother who has syphilis can spread the disease through the placenta to the unborn infant.

Congenital syphilis is caused by the organism Treponema pallidum, which is passed from mother to child during fetal development or birth. Nearly half of all children infected with syphilis while they are in the womb die shortly before or after birth.

Despite the fact that this disease can be cured with antibiotics if caught early, rising rates of syphilis among pregnant women in the United States have recently increased the number of infants born with congenital syphilis.

Symptoms in newborns may include:

• Failure to gain weight or failure to thrive
• Fever
• Irritability
• No bridge to nose (saddle nose)
• Early rash -- small blisters on the palms and soles
• Later rash -- copper-colored, flat or bumpy rash on the face, palms, and soles
• Rash of the mouth, genitalia, and anus
• Severe congenital pneumonia
• Watery discharge from the nose

Symptoms in older infants and young children may include:

• Abnormal notched and peg-shaped teeth called Hutchinson teeth
• Bone pain
• Blindness
• Clouding of the cornea
• Decreased hearing or deafness
• Gray, mucous-like patches on the anus and outer vagina
• Joint swelling
• Refusal to move a painful arm or leg
• Saber shins (bone problem of the lower leg)
• Scarring of the skin around the mouth, genitalia, and anus

If the disorder is suspected at the time of birth, the placenta will be examined for signs of syphilis. A physical examination of the infant may show signs of liver and spleen swelling and bone inflammation.

The mother may receive the following blood tests:

• FTA-ABS (fluorescent treponemal antibody absorbed test)
• RPR (Rapid plasma reagin)
• VDRL (Venereal disease research laboratory test)

An infant or child may have the following tests done:

• Bone x-ray
• Eye examination
• Lumbar puncture
• Dark-field examination to better detect syphilis-related bacteria under a microscope

Penicillin is used to treat all forms of syphilis.

Many infants who were infected early in the pregnancy are stillborn. Treatment of the expectant mother lowers the risk of congenital syphilis in the infant. Babies who become infected when passing through the birth canal have a better outlook.

• Blindness
• Deafness
• Facial deformity
• Neurological problems

Call your health care provider if your baby has signs or symptoms of this condition.

If you think that you may have syphilis and are pregnant (or anticipate becoming pregnant), call your health care provider immediately.

Safer sexual practices may help prevent syphilis. If you suspect you have a sexually transmitted disease such as syphilis, seek medical attention immediately to avoid complications like infecting a fetus during pregnancy or birth.

Prenatal care is very important. A routine blood test for syphilis is done during pregnancy. This identifies infected mothers and allows them to be treated to reduce the risks to the infant and themselves. Infants born to infected mothers who received proper penicillin treatment during pregnancy are at minimal risk for congenital syphilis.

Congenital lues; Fetal syphilis

Updated by: Deirdre O’Reilly, MD, MPH, Neonatologist, Division of Newborn Medicine, Children’s Hospital Boston and Instructor in Pediatrics, Harvard Medical School, Boston, Massachusetts. Review Provided by VeriMed Healthcare Network.