Late congenital syphilis
Transmission of T pallidum can occur in utero via the placenta after 4 months gestation, or through exposure to infectious vaginal lesions during delivery (perinatal syphilis). The subsequent signs and symptoms of congenital syphilis can be divided into two categories: (1) early congenital syphilis describes manifestations presenting before 2 years of age; (2) late congenital syphilis describes manifestations presenting after 2 years of age.
The symptoms of late congenital syphilis are analogous to tertiary syphilis in the adult. The signs and symptoms for both arise from either continued inflammatory processes against T pallidum antigens or attempts by the body to control the damage from infection in utero. Although late congenital syphilis is subclinical in 60% of cases, manifestations can occur into the early 20s and most commonly involve the bones, teeth, and nervous system. Hutchinson's triad, which is pathognomonic for late congenital syphilis, is defined by the presence of interstitial keratitis, Hutchinson incisors, and eighth nerve deafness.
A50.7 – Late congenital syphilis, unspecified
82323002 – Late congenital syphilis (2 years OR more)
Differential Diagnosis & Pitfalls
- Many of the skeletal findings of late congenital syphilis overlap with those of rickets, including frontal bossing, Higouménakis sign, and saber shins.
- In addition, in evaluating saber shins and Higouménakis sign, the possibility of underlying osteomyelitis, trauma, or tumors should be evaluated.
- Saddle nose deformities can occur with trauma and infections.
- Interstitial keratitis can occasionally occur with tuberculosis.
- Serologic tests that are reactive for syphilis can also be attributed to other non-syphilis treponemal infections, or acquired syphilis.