<prompt> Premature baby at 34wk was delivered had bullous lesion on body. X ray shows periostitis next investigation isELISA for HIVPCR for TBVDRL for mother babyHbsAg for mother  <response>: The above mentioned history is suggestive of Congenital Syphilis.So we will do VDRL of both mother and baby to confirm. Early Congenital syphilis Late Congenital syphilis appearing 2-6 weeks after bih untreated after 2 years of age Rhinitis, or snuffles Mucocutaneous lesions Bone changes :Osteochondritis, osteitis, and periostitis detectable by x-ray Long bones Hepatosplenomegaly, lymphadenopathy , Anemia, jaundice , Thrombocytopenia; and leukocytosis. Interstitial keratitis occurs at 5-25 years of age, Eighth-nerve deafness, Recurrent ahropathy. BL knee effusions - Cluttons joints. Gummatous periostitis occurs at 5-20 years of age. Classic stigmata -Hutchinsons teeth, Mulberry molars , Saddle nose and Saber shins. 