Congenital syphilis (CS): Transmission of Treponema pallidum to fetus from infected mother
Early-onset CS: Clinically manifests < 2 years of age
Late-onset CS: Clinically manifests > 2 years of age
"Great imitator" (coined by Sir William Osler)
Acquired syphilis
Occurrence of syphilis via sexual transmission
May see in sexually abused children
Primary syphilis: Chancre at site of inoculation
Secondary syphilis: Systemic disease develops weeks to months after infection
Latent syphilis: Asymptomatic period with positive serologic tests
Tertiary syphilis: Development of late complications (e.g., CNS, cardiovascular, bones, & skin)
Osseous findings in acquired syphilis typically occur in tertiary 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
Kimball A et al: Congenital syphilis diagnosed beyond the neonatal period in the United States: 2014-2018. Pediatrics. 148(3), 2021
Medoro AK et al: Syphilis in neonates and infants. Clin Perinatol. 48(2):293-309, 2021
Moodley A et al: The term newborn: congenital infections. Clin Perinatol. 48(3):485-511, 2021
Jacobs K et al: Congenital syphilis misdiagnosed as suspected nonaccidental trauma. Pediatrics. 144(4), 2019
Kan JH et al: Musculoskeletal infections. Caffey's pediatric diagnostic imaging. 13th ed. Elsevier. 1349-64, 2019
Cooper JM et al: Congenital syphilis. Semin Perinatol. 42(3):176-84, 2018
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
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
Bell C et al: Pulmonary abscesses in congenital syphilis. Arch Pathol Lab Med. 126(4):484-6, 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
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
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
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Definitions
Congenital syphilis (CS): Transmission of Treponema pallidum to fetus from infected mother
Early-onset CS: Clinically manifests < 2 years of age
Late-onset CS: Clinically manifests > 2 years of age
"Great imitator" (coined by Sir William Osler)
Acquired syphilis
Occurrence of syphilis via sexual transmission
May see in sexually abused children
Primary syphilis: Chancre at site of inoculation
Secondary syphilis: Systemic disease develops weeks to months after infection
Latent syphilis: Asymptomatic period with positive serologic tests
Tertiary syphilis: Development of late complications (e.g., CNS, cardiovascular, bones, & skin)
Osseous findings in acquired syphilis typically occur in tertiary 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
Kimball A et al: Congenital syphilis diagnosed beyond the neonatal period in the United States: 2014-2018. Pediatrics. 148(3), 2021
Medoro AK et al: Syphilis in neonates and infants. Clin Perinatol. 48(2):293-309, 2021
Moodley A et al: The term newborn: congenital infections. Clin Perinatol. 48(3):485-511, 2021
Jacobs K et al: Congenital syphilis misdiagnosed as suspected nonaccidental trauma. Pediatrics. 144(4), 2019
Kan JH et al: Musculoskeletal infections. Caffey's pediatric diagnostic imaging. 13th ed. Elsevier. 1349-64, 2019
Cooper JM et al: Congenital syphilis. Semin Perinatol. 42(3):176-84, 2018
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
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
Bell C et al: Pulmonary abscesses in congenital syphilis. Arch Pathol Lab Med. 126(4):484-6, 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
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
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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