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  • Updated 05.24.2024
  • Released 07.13.1995
  • Expires For CME 05.24.2027

Congenital syphilis

Introduction

Overview

Congenital syphilis, one of the transplacentally acquired preventable infections, can produce long-lasting morbidities in neonates. In this article, the author describes the epidemiology of congenital syphilis in the United States and developing countries as well as the clinical spectrum of the disease. Also discussed are issues pertaining to the prevention and diagnosis of congenital syphilis in the United States, as well as globally, and the treatment of presumed and proven congenital syphilis.

Historical note and terminology

Syphilis has been recognized as an infection since the beginning of the 16th century, when Ferdinand Columbus (Hernando Colón; 1488-1539), the second son of Christopher Columbus (1451-1506), described its skin manifestations among the sailors returning from the first voyage to the New World in 1493; it was termed mal de la Hispaniola. The disease spread to the Spanish soldiers who fought at the side of the King of Naples and was then renamed morbo Napolitano. The disease reached the French Troops of Charles VIII (1470-1498) during their 3-week siege of the city of Naples in 1495. When this army returned to the north, the Italian Peninsula was invaded by syphilis, and the disease became known as morbo Gallico or the “French malady.”

Ferdinand Columbus (Hernando Colón; 1488-1539)

The second son of Christopher Columbus (1451-1506) described its skin manifestations among the sailors returning from the first voyage to the New World in 1493, and it was termed mal de la Hispaniola. (Source: Bibliote...

Girolamo Fracastoro (1478-1553) of Verona became famous for his poem “Syphilis sive Morbus Gallicus” (30), in which the main character, the shepherd Syphilus, is afflicted by this disease as punishment for cursing the Gods (Frascatoro 1530; 70). This poem not only baptized the French malady with its present name, but it also hinted at its venereal origin. From Spain, the disease spread throughout Europe, and there exists exact documentation of its appearance in Asia, India (1498), China (1505), and Japan (1569) (66).

Congenital syphilis was first described in an English 17th-century pediatric textbook, although Paracelsus (Aureolus Theophrastus Bombastus von Hohenheim; 1493-1541) first suggested in utero transmission (70). As a result of this knowledge, newborns with syphilis were abandoned by their mothers because of fear of contagion. English surgeon and venereologist Sir Jonathan Hutchinson (1828-1913) described the triad of notched incisors, interstitial keratitis, and deafness as criteria for congenital syphilis diagnosis (43).

In 1905, at the Charité Clinic in Berlin, German zoologist Fritz Schaudinn (1871-1906), with the dermatologist Erich Hoffmann (1868-1959), identified the spirochete Spirochaeta pallida later called Treponema pallidum as the causative organism of syphilis (76; 67). Shortly afterward, in 1910, German physician-scientist Paul Ehrlich (1854-1915) introduced a synthetic arsenical, salvarsan, as the main line of therapy. Although toxic, it had more efficacy than previous medications, such as mercury salts and guaiac.

The natural history of untreated syphilis is well-known because of an epidemiologic study initiated in 1891 in Oslo, Norway by Norwegian dermatologist Carl Wilhelm Boeck (1808-1873/1875?). This study documented the course of the untreated disease in 1978 patients and included many autopsies.

Norwegian dermatologist Carl Wilhelm Boeck (1808-1875)

(Source: Norsk Portræt-Galleri. Christiania, Norway. Norwegian publisher and author Nils Christian Tønsberg [1813-1897], 1877. Public domain.)

The “Tuskegee Study of Untreated Syphilis in the Negro Male” was started in 1932 by the United States Public Health Service to study the natural history of syphilis in hopes of justifying treatment programs for Blacks (17). It was a notorious example of human research carried out without informed consent and with actions that were intentionally deleterious to the subjects studied.

Doctor drawing blood from a patient as part of the Tuskegee Syphilis Study

The Tuskegee Syphilis Study is a notorious example of human research carried out without informed consent and with actions that were intentionally deleterious to the subjects studied. (Source: US National Archives. Atlanta, Geo...

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