CONGENITAL SYPHILIS
CONGENITAL SYPHILIS ICD-10: A50.9
• Transmission. During gestation or intrapartum. Risk of transmission: Early maternal syphilis, 75% to 95%; >2 years’ duration, 35%.
• Pathogenesis. Lesions usually develop after the fourth month of gestation, associated with fetal immunologic competence. Pathogenesis depends on the immune response of fetus. Adequate treatment of mother before the 16th week of pregnancy prevents fetal damage. Untreated: Fetal loss up to 40%.
CLINICAL MANIFESTATION
EARLY MANIFESTATIONS Appear before 2 years of age, often at 2 to 10 weeks of age. Infectious. Resembles severe secondary syphilis in adult. Bullae, vesicles on palms and soles, superficial desquamation, petechiae, and papulosquamous lesions. Rhinitis or snuffles (23%); mucous patches, condylomata latum. Bone changes: Osteochondritis, osteitis, and periostitis. Hepatosplenomegaly, jaundice, and lymphadenopathy. Anemia, thrombocytopenia, ad leukocytosis. LATE MANIFESTATIONS Appear after 2 years of age. Noninfectious. Similar to late acquired syphilis in adults. Cardiovascular syphilis. Interstitial keratitis. Eighth nerve deafness. Recurrent arthropathy; bilateral knee effusions (Clutton joints). Gummatous periostitis
results in destructive lesions of nasal septum/ palate. Asymptomatic neurosyphilis in 33% of patients; clinical syphilis in 25%. RESIDUAL STIGMATA Hutchinson teeth (centrally notched, widely spaced, peg-shaped upper central incisors; “mulberry” molars [multiple poorly developed cusps]). Abnormal facies: Frontal bossing, saddle nose, poorly developed maxillae, and rhagades (linear scars at angles of mouth, caused by bacterial secondary infection of early facial eruption). Saber shins. Nerve deafness. Old chorioretinitis, optic atrophy, and corneal opacities caused by interstitial keratitis.
TREATMENT
Consult CDC guidelines.