Congenital syphilis is a transplacentally transmitted infection that occurs in infants of untreated or inadequately treated mothers. The physical findings at birth are quite variable: The infant may have many or minimal signs or even no signs until 6-8 weeks of life (delayed form). The most common findings are on the mucous membranes and skin - maculopapular rash, condylomas, mucous membrane patches, and serous nasal discharge (snuffles). These lesions are infectious; T pallidum can easily be found microscopically, and the infant must be isolated. Other common findings are hepatosplenomegaly, anemia, or osteochondritis. These early active lesions subsequently heal, and if the disease is left untreated it produces the characteristic stigmas of syphilis - interstitial keratitis, Hutchinson’s teeth, saddle nose, saber shins, deafness, and central nervous system involvement.

The presence of negative serologic tests at birth in both the mother and the infant usually means that the newborn is free of infection. However, recent infection near the time of delivery may result in negative tests because there has been insufficient time to develop a serologic response. Thus, it is necessary to maintain a high index of suspicion in infants who present with delayed onset of symptoms despite negative serologic tests at birth, especially in infants born to high-risk mothers (HIV-positive, illicit drug users). All infants born to mothers with positive nontreponemal and treponemal antibody titers should have blood drawn for an RPR or VDRL test and, if positive, be referred to a pediatrician for further evaluation and therapy.

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