A condition caused by infection in utero with Treponema pallidum. A wide spectrum of severity exists, and only severe cases are clinically apparent at birth. An infant (less than 2 years) may have signs such as hepatosplenomegaly, characteristic skin rash, condyloma lata, snuffles, jaundice (non-viral hepatitis), pseudoparalysis, anemia, or edema (nephrotic syndrome and/or malnutrition). An older child may have stigmata such as interstitial keratitis, nerve deafness, anterior bowing of shins, frontal bossing, mulberry molars, Hutchinson teeth, saddle nose, rhagades, or Clutton joints.
Laboratory Criteria for Diagnosis
Demonstration of T. pallidum by darkfield microscopy, fluorescent antibody, or other specific stains in specimens from lesions, placenta, umbilical cord, or autopsy material.
The infection of an infant whose mother had untreated or inadequately treated* syphilis at delivery, regardless of signs in the infant; or the infection of an infant or child who has a reactive treponemal test for syphilis and any one of the following:
- Any evidence of congenital syphilis on physical examination
- Any evidence of congenital syphilis on long bone x-ray
- A reactive cerebrospinal fluid (CSF) VDRL
- An elevated CSF cell count or protein (without other cause)
- A reactive test for fluorescent treponemal antibody absorbed-19S-IgM antibody
A case (among infants) that is laboratory confirmed.
Congenital and acquired syphilis may be difficult to distinguish when a child is seropositive after infancy. Signs of congenital syphilis may not be obvious, and stigmata may not yet have developed. Abnormal values for CSF VDRL, cell count, and protein, as well as IgM antibodies, may be found in either congenital or acquired syphilis. Findings on long bone x-rays may help, since x-ray changes in the metaphysis and epiphysis are considered classic for congenitally acquired disease. The decision may ultimately be based on maternal history and clinical judgment. The possibility of sexual abuse should be considered. For reporting purposes, congenital syphilis includes cases of congenitally acquired syphilis among infants and children, as well as syphilitic stillbirths.
*Inadequate treatment consists of any non-penicillin therapy or penicillin given less than 30 days before delivery.