Congenital syphilis is syphilis present in utero and at birth, and occurs when a child is born to a mother with syphilis. Untreated early syphilis infections results in a high risk of poor pregnancy outcomes, including saddle nose, lower extremity abnormalities, miscarriages, premature births, stillbirths, or death in newborns. Some infants with congenital syphilis have symptoms at birth, but many develop symptoms later. Symptoms may include rash, fever, an enlarged liver and spleen, and skeletal abnormalities. Newborns will typically not develop a primary syphilitic chancre but may present with signs of secondary syphilis (i.e. generalized body rash). Often these babies will develop syphilitic rhinitis ("snuffles"), the mucus from which is laden with the T. pallidum bacterium, and therefore highly infectious. If a baby with congenital syphilis is not treated early, damage to the bones, teeth, eyes, ears, and brain can occur. Classification Early This is a subset of cases of congenital syphilis. Newborns may be asymptomatic and are only identified on routine prenatal screening. If not identified and treated, these newborns develop poor feeding and runny nose. By definition, early congenital syphilis occurs in children between 0 and 2 years old. Late Late congenital syphilis is a subset of cases of congenital syphilis. By definition, it occurs in children at or greater than 2 years of age who acquired the infection trans-placentally. Symptoms include: Blunted upper incisor teeth known as Hutchinson's teeth Deafness from auditory nerve disease Frontal bossing (prominence of the brow ridge) Hard palate defect Inflammation of the cornea known as interstitial keratitis Protruding mandible Saber shins Saddle nose (collapse of the bony part of nose) Short maxillae Swollen knees A frequently-found group of symptoms is Hutchinson's triad, which consists of Hutchinson's teeth (notched incisors), keratitis and deafness and occurs in 63% of cases. Treatment (with penicillin) before the development of late symptoms is essential. Signs and symptoms Abnormal x-rays Anemia Cerebral palsy Du Bois sign, narrowing of the little finger Enlarged liver Enlarged spleen Frontal bossing Sensorineural hearing loss Higouménakis' sign, enlargement of the sternal end of clavicle in late congenital syphilis 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 inflammation of the cornea which can lead to corneal scarring and potential blindness Hydrocephalus Jaundice Lymph node enlargement Mulberry molars (permanent first molars with multiple poorly developed cusps) Musculoskeletal deformities Petechiae