Congenital syphilis physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2]Aravind Kuchkuntla, M.B.B.S[3]

Congenital syphilis examination findings include characteristic skin rash, hepatosplenomegaly and interstitial keratitis.

• Low birth weight
• Presence of the signs of prematurity
• Nonimmune hydrops : It is characteristic of congenital syphilis and the features of non-immune hydrops include ascites, pericardial effusion, pleural effusion and skin edema, however Rh incompatability should be ruled out as a cause of hydrops.^[1]

• Vesiculobullous or maculopapular rash occurring on the palms and soles is present in 70% of the children with congenital syphilis. Other patterns of rash such as condylomata lata lesions, annular lesions, and erythema multiforme -like targetoid lesions are present in affected infants.^[2]
• Later rash – copper-colored, flat or bumpy rash on the face, palms, and soles

• Frontal bossing
• Poorly developed maxillae

• Corneal clouding^[3]
• Interstitial keratitis (IK), an inflamation of the cornea which can lead to corneal scarring and potentially blindness
• Anemia
• Jaundice

• Deafness

• Snuffles, the name given to rhinitis in this situation. When chronic, this can lead to saddle nose deformity.
• Rhagades, linear scars at the angles of the mouth and nose result from bacterial infection of skin lesions

Shown below is an image of Hutchinson’s teeth

• Hutchinson’s Triad, a set of symptoms consisting of deafness, hutchinson’s teeth (centrally notched, widely-spaced peg-shaped upper central incisors), and interstitial keratitis (IK), an inflamation of the cornea which can lead to corneal scarring and potentially blindness
• Mulberry molars (sixth year molars with multiple poorly developed cusps)

• Enlarged liver
• Enlarged spleen

• Sabre shins: sharp-edged anteriorly convex tibia
• Lymph node enlargement
• Pseudoparalysis

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