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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Definitions
Congenital syphilis (CS): Transmission of Treponema pallidum (T. pallidum) to fetus from infected mother
Early-onset CS: Clinically manifests < 2 years of age
Late-onset CS: Clinically manifests > 2 years of age
"The great imitator" (coined by Sir William Osler)
Acquired syphilis
Occurrence of syphilis via sexual transmission
May see in sexually abused children
1° syphilis: Chancre at site of inoculation
2° syphilis: Systemic disease develops weeks to months after infection
Latent syphilis: Asymptomatic period but serologic tests positive
3° syphilis: Development of late complications (e.g., central nervous system, cardiovascular, bones, & skin)
Osseous findings in acquired syphilis typically occur in 3° syphilis
IMAGING
General Features
Radiographic Findings
Ultrasonographic Findings
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Microscopic Features
Laboratory Tests
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Moline HR et al: The continuing threat of syphilis in pregnancy. Curr Opin Obstet Gynecol. 28(2):101-4, 2016
Bowen V et al: Increase in incidence of congenital syphilis - United States, 2012-2014. MMWR Morb Mortal Wkly Rep. 64(44):1241-5, 2015
Kan JH et al: Musculoskeletal infections. Caffey's pediatric diagnostic imaging. 12th ed. Philadelphia, PA: Saunders. 1471-1487.e2, 2013
Rac MW et al: Progression of ultrasound findings of fetal syphilis after maternal treatment. Am J Obstet Gynecol. 211(4):426.e1-6, 2014
Araujo Júnior E et al: Prenatal diagnosis of congenital syphilis using two- and three-dimensional ultrasonography: case report. Case Rep Infect Dis. 2012:478436, 2012
Miller R et al: Commentary. Update on emerging infections: news from the Centers for Disease Control and Prevention. Congenital syphilis--United States 2003-2008. Ann Emerg Med. 56(3):296-7, 2010
Sendagorta E et al: Congenital syphilis, case report and epidemiologic features in Spain. Pediatr Dermatol. 27(3):308-9, 2010
Lee G et al: Congenital syphilis as a differential diagnosis of non-accidental injury. Eur J Pediatr. 167(9):1071-2, 2008
Bell C et al: Pulmonary abscesses in congenital syphilis. Arch Pathol Lab Med. 126(4):484-6, 2002
Busby G et al: Value of routine long bone radiographs in management of babies with a positive VDRL at the Mount Hope Women's Hospital. West Indian Med J. 51(4):225-7, 2002
Nolt D et al: Survival with hypopituitarism from congenital syphilis. Pediatrics. 109(4):e63, 2002
Coimbra AV et al: Weismann-Netter-Stuhl syndrome: first Brazilian case reports. Joint Bone Spine. 67(6):539-43, 2000
Ajayi NA et al: Intestinal ulceration, obstruction, and haemorrhage in congenital syphilis. Pediatr Surg Int. 15(5-6):391-3, 1999
Christian CW et al: Preschoolers with syphilis. Pediatrics. 103(1):E4, 1999
Moyer VA et al: Contribution of long-bone radiographs to the management of congenital syphilis in the newborn infant. Arch Pediatr Adolesc Med. 152(4):353-7, 1998
Kocher MS et al: Parrot pseudoparalysis of the upper extremities. A case report. J Bone Joint Surg Am. 78(2):284-7, 1996
Ghadouane M et al: Skeletal lesions in early congenital syphilis (a review of 86 cases). Rev Rhum Engl Ed. 62(6):433-7, 1995
Herman TE: Extensive hepatic calcification secondary to fulminant neonatal syphilitic hepatitis. Pediatr Radiol. 25(2):120-2, 1995
Lim HK et al: Congenital syphilis mimicking child abuse. Pediatr Radiol. 25(7):560-1, 1995
Shah AM et al: Late onset congenital syphilis. Indian Pediatr. 32(7):795-8, 1995
Starling SP: Syphilis in infants and young children. Pediatr Ann. 23(7):334-40, 1994
Rasool MN et al: The skeletal manifestations of congenital syphilis. A review of 197 cases. J Bone Joint Surg Br. 71(5):752-5, 1989
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Definitions
Congenital syphilis (CS): Transmission of Treponema pallidum (T. pallidum) to fetus from infected mother
Early-onset CS: Clinically manifests < 2 years of age
Late-onset CS: Clinically manifests > 2 years of age
"The great imitator" (coined by Sir William Osler)
Acquired syphilis
Occurrence of syphilis via sexual transmission
May see in sexually abused children
1° syphilis: Chancre at site of inoculation
2° syphilis: Systemic disease develops weeks to months after infection
Latent syphilis: Asymptomatic period but serologic tests positive
3° syphilis: Development of late complications (e.g., central nervous system, cardiovascular, bones, & skin)
Osseous findings in acquired syphilis typically occur in 3° syphilis
IMAGING
General Features
Radiographic Findings
Ultrasonographic Findings
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Microscopic Features
Laboratory Tests
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Moline HR et al: The continuing threat of syphilis in pregnancy. Curr Opin Obstet Gynecol. 28(2):101-4, 2016
Bowen V et al: Increase in incidence of congenital syphilis - United States, 2012-2014. MMWR Morb Mortal Wkly Rep. 64(44):1241-5, 2015
Kan JH et al: Musculoskeletal infections. Caffey's pediatric diagnostic imaging. 12th ed. Philadelphia, PA: Saunders. 1471-1487.e2, 2013
Rac MW et al: Progression of ultrasound findings of fetal syphilis after maternal treatment. Am J Obstet Gynecol. 211(4):426.e1-6, 2014
Araujo Júnior E et al: Prenatal diagnosis of congenital syphilis using two- and three-dimensional ultrasonography: case report. Case Rep Infect Dis. 2012:478436, 2012
Miller R et al: Commentary. Update on emerging infections: news from the Centers for Disease Control and Prevention. Congenital syphilis--United States 2003-2008. Ann Emerg Med. 56(3):296-7, 2010
Sendagorta E et al: Congenital syphilis, case report and epidemiologic features in Spain. Pediatr Dermatol. 27(3):308-9, 2010
Lee G et al: Congenital syphilis as a differential diagnosis of non-accidental injury. Eur J Pediatr. 167(9):1071-2, 2008
Bell C et al: Pulmonary abscesses in congenital syphilis. Arch Pathol Lab Med. 126(4):484-6, 2002
Busby G et al: Value of routine long bone radiographs in management of babies with a positive VDRL at the Mount Hope Women's Hospital. West Indian Med J. 51(4):225-7, 2002
Nolt D et al: Survival with hypopituitarism from congenital syphilis. Pediatrics. 109(4):e63, 2002
Coimbra AV et al: Weismann-Netter-Stuhl syndrome: first Brazilian case reports. Joint Bone Spine. 67(6):539-43, 2000
Ajayi NA et al: Intestinal ulceration, obstruction, and haemorrhage in congenital syphilis. Pediatr Surg Int. 15(5-6):391-3, 1999
Christian CW et al: Preschoolers with syphilis. Pediatrics. 103(1):E4, 1999
Moyer VA et al: Contribution of long-bone radiographs to the management of congenital syphilis in the newborn infant. Arch Pediatr Adolesc Med. 152(4):353-7, 1998
Kocher MS et al: Parrot pseudoparalysis of the upper extremities. A case report. J Bone Joint Surg Am. 78(2):284-7, 1996
Ghadouane M et al: Skeletal lesions in early congenital syphilis (a review of 86 cases). Rev Rhum Engl Ed. 62(6):433-7, 1995
Herman TE: Extensive hepatic calcification secondary to fulminant neonatal syphilitic hepatitis. Pediatr Radiol. 25(2):120-2, 1995
Lim HK et al: Congenital syphilis mimicking child abuse. Pediatr Radiol. 25(7):560-1, 1995
Shah AM et al: Late onset congenital syphilis. Indian Pediatr. 32(7):795-8, 1995
Starling SP: Syphilis in infants and young children. Pediatr Ann. 23(7):334-40, 1994
Rasool MN et al: The skeletal manifestations of congenital syphilis. A review of 197 cases. J Bone Joint Surg Br. 71(5):752-5, 1989
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