CCMS Medicine Spring 2017 - 11

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other causes; or (e) a reactive fluorescent treponemal antibody
absorbed-19S-IgM antibody test or IgM ELISA. A modified 2015
version is available at wwwn.cdc.gov/nndss/conditions/congenitalsyphilis/case-definition/2015 which substitutes the PCR test for
the IgM tests.

To support Sir William's statement, it doesn't take a lot of
medical literature review to demonstrate that this one clinical
entity can, and does, have implications for just about every
medical specialty and could present in those clinical offices/sites in
any of its guises: General Medicine, Internal Medicine, Infectious
Diseases, Dermatology, Emergency Room, Public Health Clinics,
Ob/GYN, Pediatrics, Neonatology, Urology, Immunology,
Orthopedics, Psychiatry, Cardiology, and Neuro- and Thoracic/
C-V Surgery. Not to be forgotten, of course, is the fact that
infectious specimens may be sent to Pathology, Hematology and
Serology labs.
Recent ProMED reports (4-6) from across the nation (AL, TX,
NM, CA, WA, CT, PA) have documented the various outbreaks
and increasing incidence of "infectious syphilis" [defined as the
sum of reported primary and secondary cases (P & S) of syphilis].
After 1946, the number of P & S cases had dropped by 99% (7)
presumably the combined result of mass STS screening programs,
premarital and prenatal testing programs, public health education
efforts, and the introduction of penicillin, as well as the more
traditional public mores of early-mid twentieth century America.
In 2000-01 the national P&S rate was only 2.1/100,000
population, which was the lowest rate since reporting began in
1941. However, every year since 2001 the rate has continued
to increase and, by 2015, it rose to 7.5/100,000 population, a
dramatic 357-fold increase in less than one generation! One report
(Feb, 2016) from Nevada speaks of "an explosion of early syphilis
cases".... many presumed to be related to Las Vegas' tourism,
gambling, prostitution, conventions and business meetings.
It is true, of course, that a great deal of these current-day
cases were diagnosed in "men who have sex with men" (MSM),
but breaking the statistics down further shows that in 201415 the P&S syphilis rates rose 18.1% in males, but 27.3% in
females! This awareness has increased national concerns about the
ramifications. It appears that the disease spreads even further when
infected bisexual males have unprotected sex with heterosexual
females, with prostitutes, and with drug-addicted women who will
trade sex for drugs to feed their habit. Young Americans are also
at growing risk: youth aged 15-24 constitute 27% of the sexually
active population, but now account for 50% of newly reported
STDs.

Unfortunately, as P&S rates rebound there is a terrible
consequence which should be completely preventable. Whereas
children had been the chief beneficiaries of the introduction of
penicillin in the early battle against infectious diseases (8), we now
see, pari passu, a totally unnecessary and preventable increase in
cases of congenital syphilis.
Congenital syphilis (CS, a.k.a. congenital lues, fetal syphilis)
occurs with high frequency in babies of pregnant women with
untreated early syphilis infection. National data indicate that 40%
or more of babies born to women with untreated syphilis end up
in miscarriages, stillbirths, failure to
thrive and/or infant deaths.(4)
The early stage of CS is
characterized by the appearance of signs
and symptoms before the age of 2. The
earlier the onset in the first few weeks
of life, usually the poorer the prognosis.
However, according to a Mayo Clinic
report, most newborns have no
symptoms although some may show a
rash on their palms and/or soles.
Newborns with CS may present
with failure to thrive, fever, irritability,
teeth deformities, saddle nose, profuse
watery mucosal discharge from the
nose and mouth ("snuffles") (Figure
1), rash of the mouth (Figure 2),
genitalia, or skin. The rash may
start as small vesicles or bullae and
later change to copper-colored flat
papulosquamous lesions or may form
typical condylomata lata, and later
show a symmetrical distribution like
that of acquired syphilis (Figure 3).
Older infants and young children
may present with Hutchinson's teeth
(Figure 4), bone pains, blindness,
clouding of the cornea (Figure 5),
decreased hearing or even deafness,
gray mucus-like patches of the anus
or vulva, joint swelling, saber shins
(Figure 6), refusal to move painful
limbs, scarring of the skin around the
mouth, genitalia or anus, and possibly
perforation of the palate due to
formation of gummatous destruction
(Figure 7).
Continued on page 12
All photos courtesy of the CDC/PHL
S P R I N G 2 0 1 7 | C H E S T E R C O U N T Y M E D I C I N E 11

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Table of Contents for the Digital Edition of CCMS Medicine Spring 2017