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Syphilis
Arthur B. Meyers, MD
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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

                                        1. Moline HR et al: The continuing threat of syphilis in pregnancy. Curr Opin Obstet Gynecol. 28(2):101-4, 2016
                                        2. Bowen V et al: Increase in incidence of congenital syphilis - United States, 2012-2014. MMWR Morb Mortal Wkly Rep. 64(44):1241-5, 2015
                                        3. Kan JH et al: Musculoskeletal infections. Caffey's pediatric diagnostic imaging. 12th ed. Philadelphia, PA: Saunders. 1471-1487.e2, 2013
                                        4. Rac MW et al: Progression of ultrasound findings of fetal syphilis after maternal treatment. Am J Obstet Gynecol. 211(4):426.e1-6, 2014
                                        5. 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
                                        6. 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
                                        7. Sendagorta E et al: Congenital syphilis, case report and epidemiologic features in Spain. Pediatr Dermatol. 27(3):308-9, 2010
                                        8. Lee G et al: Congenital syphilis as a differential diagnosis of non-accidental injury. Eur J Pediatr. 167(9):1071-2, 2008
                                        9. Bell C et al: Pulmonary abscesses in congenital syphilis. Arch Pathol Lab Med. 126(4):484-6, 2002
                                        10. 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
                                        11. Nolt D et al: Survival with hypopituitarism from congenital syphilis. Pediatrics. 109(4):e63, 2002
                                        12. Coimbra AV et al: Weismann-Netter-Stuhl syndrome: first Brazilian case reports. Joint Bone Spine. 67(6):539-43, 2000
                                        13. Ajayi NA et al: Intestinal ulceration, obstruction, and haemorrhage in congenital syphilis. Pediatr Surg Int. 15(5-6):391-3, 1999
                                        14. Christian CW et al: Preschoolers with syphilis. Pediatrics. 103(1):E4, 1999
                                        15. 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
                                        16. Kocher MS et al: Parrot pseudoparalysis of the upper extremities. A case report. J Bone Joint Surg Am. 78(2):284-7, 1996
                                        17. Ghadouane M et al: Skeletal lesions in early congenital syphilis (a review of 86 cases). Rev Rhum Engl Ed. 62(6):433-7, 1995
                                        18. Herman TE: Extensive hepatic calcification secondary to fulminant neonatal syphilitic hepatitis. Pediatr Radiol. 25(2):120-2, 1995
                                        19. Lim HK et al: Congenital syphilis mimicking child abuse. Pediatr Radiol. 25(7):560-1, 1995
                                        20. Shah AM et al: Late onset congenital syphilis. Indian Pediatr. 32(7):795-8, 1995
                                        21. Starling SP: Syphilis in infants and young children. Pediatr Ann. 23(7):334-40, 1994
                                        22. 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

                                                                              1. Moline HR et al: The continuing threat of syphilis in pregnancy. Curr Opin Obstet Gynecol. 28(2):101-4, 2016
                                                                              2. Bowen V et al: Increase in incidence of congenital syphilis - United States, 2012-2014. MMWR Morb Mortal Wkly Rep. 64(44):1241-5, 2015
                                                                              3. Kan JH et al: Musculoskeletal infections. Caffey's pediatric diagnostic imaging. 12th ed. Philadelphia, PA: Saunders. 1471-1487.e2, 2013
                                                                              4. Rac MW et al: Progression of ultrasound findings of fetal syphilis after maternal treatment. Am J Obstet Gynecol. 211(4):426.e1-6, 2014
                                                                              5. 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
                                                                              6. 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
                                                                              7. Sendagorta E et al: Congenital syphilis, case report and epidemiologic features in Spain. Pediatr Dermatol. 27(3):308-9, 2010
                                                                              8. Lee G et al: Congenital syphilis as a differential diagnosis of non-accidental injury. Eur J Pediatr. 167(9):1071-2, 2008
                                                                              9. Bell C et al: Pulmonary abscesses in congenital syphilis. Arch Pathol Lab Med. 126(4):484-6, 2002
                                                                              10. 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
                                                                              11. Nolt D et al: Survival with hypopituitarism from congenital syphilis. Pediatrics. 109(4):e63, 2002
                                                                              12. Coimbra AV et al: Weismann-Netter-Stuhl syndrome: first Brazilian case reports. Joint Bone Spine. 67(6):539-43, 2000
                                                                              13. Ajayi NA et al: Intestinal ulceration, obstruction, and haemorrhage in congenital syphilis. Pediatr Surg Int. 15(5-6):391-3, 1999
                                                                              14. Christian CW et al: Preschoolers with syphilis. Pediatrics. 103(1):E4, 1999
                                                                              15. 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
                                                                              16. Kocher MS et al: Parrot pseudoparalysis of the upper extremities. A case report. J Bone Joint Surg Am. 78(2):284-7, 1996
                                                                              17. Ghadouane M et al: Skeletal lesions in early congenital syphilis (a review of 86 cases). Rev Rhum Engl Ed. 62(6):433-7, 1995
                                                                              18. Herman TE: Extensive hepatic calcification secondary to fulminant neonatal syphilitic hepatitis. Pediatr Radiol. 25(2):120-2, 1995
                                                                              19. Lim HK et al: Congenital syphilis mimicking child abuse. Pediatr Radiol. 25(7):560-1, 1995
                                                                              20. Shah AM et al: Late onset congenital syphilis. Indian Pediatr. 32(7):795-8, 1995
                                                                              21. Starling SP: Syphilis in infants and young children. Pediatr Ann. 23(7):334-40, 1994
                                                                              22. 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