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Syphilis
Arthur B. Meyers, MD
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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

                                      1. Kimball A et al: Congenital syphilis diagnosed beyond the neonatal period in the United States: 2014-2018. Pediatrics. 148(3), 2021
                                      2. Medoro AK et al: Syphilis in neonates and infants. Clin Perinatol. 48(2):293-309, 2021
                                      3. Moodley A et al: The term newborn: congenital infections. Clin Perinatol. 48(3):485-511, 2021
                                      4. Jacobs K et al: Congenital syphilis misdiagnosed as suspected nonaccidental trauma. Pediatrics. 144(4), 2019
                                      5. Kan JH et al: Musculoskeletal infections. Caffey's pediatric diagnostic imaging. 13th ed. Elsevier. 1349-64, 2019
                                      6. Cooper JM et al: Congenital syphilis. Semin Perinatol. 42(3):176-84, 2018
                                      7. Moline HR et al: The continuing threat of syphilis in pregnancy. Curr Opin Obstet Gynecol. 28(2):101-4, 2016
                                      8. Bowen V et al: Increase in incidence of congenital syphilis - United States, 2012-2014. MMWR Morb Mortal Wkly Rep. 64(44):1241-5, 2015
                                      9. Rac MW et al: Progression of ultrasound findings of fetal syphilis after maternal treatment. Am J Obstet Gynecol. 211(4):426.e1-6, 2014
                                      10. 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
                                      11. 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
                                      12. Bell C et al: Pulmonary abscesses in congenital syphilis. Arch Pathol Lab Med. 126(4):484-6, 2002
                                      13. Nolt D et al: Survival with hypopituitarism from congenital syphilis. Pediatrics. 109(4):e63, 2002
                                      14. Coimbra AV et al: Weismann-Netter-Stuhl syndrome: first Brazilian case reports. Joint Bone Spine. 67(6):539-43, 2000
                                      15. Ajayi NA et al: Intestinal ulceration, obstruction, and haemorrhage in congenital syphilis. Pediatr Surg Int. 15(5-6):391-3, 1999
                                      16. Christian CW et al: Preschoolers with syphilis. Pediatrics. 103(1):E4, 1999
                                      17. 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
                                      18. Ghadouane M et al: Skeletal lesions in early congenital syphilis (a review of 86 cases). Rev Rhum Engl Ed. 62(6):433-7, 1995
                                      19. Herman TE: Extensive hepatic calcification secondary to fulminant neonatal syphilitic hepatitis. Pediatr Radiol. 25(2):120-2, 1995
                                      20. Starling SP: Syphilis in infants and young children. Pediatr Ann. 23(7):334-40, 1994
                                      21. 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

                                                                          1. Kimball A et al: Congenital syphilis diagnosed beyond the neonatal period in the United States: 2014-2018. Pediatrics. 148(3), 2021
                                                                          2. Medoro AK et al: Syphilis in neonates and infants. Clin Perinatol. 48(2):293-309, 2021
                                                                          3. Moodley A et al: The term newborn: congenital infections. Clin Perinatol. 48(3):485-511, 2021
                                                                          4. Jacobs K et al: Congenital syphilis misdiagnosed as suspected nonaccidental trauma. Pediatrics. 144(4), 2019
                                                                          5. Kan JH et al: Musculoskeletal infections. Caffey's pediatric diagnostic imaging. 13th ed. Elsevier. 1349-64, 2019
                                                                          6. Cooper JM et al: Congenital syphilis. Semin Perinatol. 42(3):176-84, 2018
                                                                          7. Moline HR et al: The continuing threat of syphilis in pregnancy. Curr Opin Obstet Gynecol. 28(2):101-4, 2016
                                                                          8. Bowen V et al: Increase in incidence of congenital syphilis - United States, 2012-2014. MMWR Morb Mortal Wkly Rep. 64(44):1241-5, 2015
                                                                          9. Rac MW et al: Progression of ultrasound findings of fetal syphilis after maternal treatment. Am J Obstet Gynecol. 211(4):426.e1-6, 2014
                                                                          10. 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
                                                                          11. 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
                                                                          12. Bell C et al: Pulmonary abscesses in congenital syphilis. Arch Pathol Lab Med. 126(4):484-6, 2002
                                                                          13. Nolt D et al: Survival with hypopituitarism from congenital syphilis. Pediatrics. 109(4):e63, 2002
                                                                          14. Coimbra AV et al: Weismann-Netter-Stuhl syndrome: first Brazilian case reports. Joint Bone Spine. 67(6):539-43, 2000
                                                                          15. Ajayi NA et al: Intestinal ulceration, obstruction, and haemorrhage in congenital syphilis. Pediatr Surg Int. 15(5-6):391-3, 1999
                                                                          16. Christian CW et al: Preschoolers with syphilis. Pediatrics. 103(1):E4, 1999
                                                                          17. 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
                                                                          18. Ghadouane M et al: Skeletal lesions in early congenital syphilis (a review of 86 cases). Rev Rhum Engl Ed. 62(6):433-7, 1995
                                                                          19. Herman TE: Extensive hepatic calcification secondary to fulminant neonatal syphilitic hepatitis. Pediatr Radiol. 25(2):120-2, 1995
                                                                          20. Starling SP: Syphilis in infants and young children. Pediatr Ann. 23(7):334-40, 1994
                                                                          21. 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