Congenital syphilis

Alternative names
Congenital lues; Fetal syphilis

Congenital syphilis is an infection caused by the spirochete Treponema pallidum (syphilis) passed from mother to child during fetal development or birth.

Causes, incidence, and risk factors

An expectant mother who is infected with syphilis can transmit the disease through the placenta to the unborn infant. Congenital syphilis is a severe, disabling, and often life-threatening condition for the infant. Nearly half of all children infected with syphilis during gestation die shortly before or after birth.

Infants who survive develop early-stage and late-stage symptoms of syphilis, if not treated. Early-stage symptoms include irritability, failure to thrive, and nonspecific fever. Some infants develop a rash and lesions (sores) on the borders of the mouth, anus, and genitalia (called condyloma lata).

Some of these lesions may resemble the wart-like lesions of adult syphilis. A small percentage of infants have a watery nasal discharge (sniffles) and a saddle nose deformity resulting from infection in the cartilage of the nose. Bone lesions are common, especially in the upper arm (humerus).

Later signs appear as tooth abnormalities (Hutchinson teeth), bone changes (saber shins), neurological involvement, blindness, and deafness. Despite the fact that this disease can be cured with antibiotics if caught early, rising rates of syphilis amongst pregnant women in the United States have recently increased the number of infants born with congenital syphilis.


  • Irritability  
  • Failure to gain weight or failure to thrive  
  • Watery discharge from the nose  
  • Early rash - small blisters (vesicles) on the palms and soles  
  • Later rash - copper-colored, flat or bumpy (maculopapular) rash on the face, palms, soles  
  • Rash at the junction of the skin and mucus membranes of the mouth, genitalia, and anus  
  • No bridge to nose (saddle nose)  
  • Severe congenital pneumonia, referred on an x-ray as “whiteout” or pneumonia alba


  • Bone pain  
  • Refusal to move a painful extremity  
  • Saber shins (bone abnormality of the lower leg)  
  • Joint swelling (joint effusion)  
  • Abnormal teeth (notched and peg shaped - called Hutchinson teeth)  
  • Scarring of the skin around earlier lesions on the mouth, genitalia, and anus (called rhagades)  
  • Visual loss  
  • Clouding of the cornea  
  • Decreased hearing or deafness  
  • Gray, mucous-like patches on the anus and outer vagina (condyloma lata)

There may be a history of syphilis in the expectant mother.

Signs and tests

The physical examination may show signs of bone inflammation (periosteal elevations or osteochondritis). There may be evidence of hepatomegaly (enlarged liver) and splenomegaly (enlarged spleen).

Tests on the mother may include:

  • VDRL  
  • FTA-ABS (fluorescent treponemal antibody test)

If the disorder is suspected at the time of birth, the placenta will be examined for signs of syphilis.

  • For an older infant or child, tests may include:       o Serologic test for syphilis (VDRL and FTA-ABS)       o Lumbar puncture to look for evidence of syphilis in the brain and central nervous system       o Eye examination by an ophthalmologist       o Microscopy, dark field examination (demonstrates Treponema pallidum)       o X-ray of the bones

Penicillin is the treatment for all forms of syphilis. Infants born to infected mothers who received adequate penicillin treatment during pregnancy are at minimal risk.

Expectations (prognosis)
Many infants who were infected early in the pregnancy are stillborn. Treatment of the expectant mother lowers the risk of congenital syphilis in the infant. Babies who acquire syphilis in the birth canal have a better prognosis.


  • Blindness  
  • Deafness  
  • Facial deformity  
  • Neurological abnormalities

Calling your health care provider
Call your health care provider if your baby has signs or symptoms as described in this document.

If you suspect that you may be infected with syphilis and are pregnant (or anticipate becoming pregnant), call your health care provider immediately.


Safer sexual practices may help prevent infection with syphilis. If you suspect you have a sexually-transmitted disease like syphilis, seek medical attention immediately to avoid complications like infecting a fetus during pregnancy or birth.

Prenatal care for expectant mothers is critical. During prenatal care evaluations, a routine serologic test for syphilis is done. This identifies infected mothers and allows them to be treated to minimize the risks to the infant and to themselves.

Johns Hopkins patient information

Last revised: December 4, 2012
by Harutyun Medina, M.D.

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