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- [Voiceover] Congenital syphilis or syphilis that a newborn will contract while still in their mother's uterus. So we'll write contract in uteru or contract in uterus. Congenital syphilis is an important disease to screen for in pregnant women because 2/3 of infected neonates or newborns have no symptoms. They're without symptoms. Many of these babies will start to get features of syphilis later on. We can split the types of symptoms a baby will have based on time. There are early symptoms which occur from birth, so they can be present right away in that 1/3 that do have symptoms at birth to the first few years of life. This is in contrast to late syphilis or late congenital syphilis where you won't see any of the symptoms I'll list here from birth, but they happen after the first few years. Now, one of the first things that you might see in a newborn that's infected with syphilis is a really big liver. So let me draw a giant liver here. This is a really big liver. Then on top of that, they can also have a giant spleen. So I'll draw the spleen really big here as well. We refer to this, when they happen together, as hepato, so hepato referring to the liver, spleno, so the spleno referring of course to the spleen. So, hepatosplenomegaly. Hepatosplenomegaly. The reason why this happens is because the white blood cells from the baby as well as from the mother are actively fighting the syphilis treponemes that are present in the liver as well as in the spleen. The reason why these two organs are affected more than others is because the liver and the spleen are responsible for making white blood cells in fetuses as well as early on in newborns. Another early symptom you might see of congenital syphilis is the same maculopapular rash that we saw with secondary syphilis. So I'll write here again, this is a maculo which means a flat, "papular"which means are raised or bumpy lesions. So a maculopapular rash that occurs all over the body, but is very characteristic to syphilis in that it occurs on the palms and the soles of the feet. There are only a handful of disease that'll cause this many types of lesions on your hands. Remember, it's not just one but several of these maculopapular lesions that are present. Then finally the last early symptom we might see of syphilis is pneumonia. So let me just draw the lungs here. I'll purposely draw them small because in a newborn, lungs are still developing. So in this critical period, already, we can start to get an infection of the lungs, which again is called pneumonia because of the spread of syphilis there as well. Then later on, some of the symptoms that we'll see in an infant are related to white blood cells fighting syphilis over a long period of time. One example of this is what's referred to as a saddle nose deformity. A saddle nose deformity. Which just means that the baby's nose looks like saddle. Like the same thing you'd use to ride a horse. This is all happening because white blood cells are fighting these syphilis treponemes producing inflammation. This is inflammation specifically happening near the nasal cartilage. So at the nose, you'll see this characteristic divot that shows that there's been some breakdown of the nasal cartilage there. A similar thing can happen on the shins or on your tibia bone leading to what's referred to as saber shin deformity. I'll write here because it affects the baby's growing tibia. I think the name describes this condition as well because the shins which are usually supposed to be bumpy tend to be very sharp in babies that have this type of deformity. It's because the white blood cells fighting the syphilis trepanemes will actually shave off the sides of the tibia bone to make it sharper than it's usually supposed to be. I think you can feel your tibia right on the front of your leg. You can notice that it's not sharp, but in an infected baby with congenital syphilis, one of the late symptoms would be that these shins would be sharper like a saber or a sword. Another late symptom you can have is what's referred to as Hutchinson's teeth. Hutchinson's teeth, which is named after someone who many consider to be the father of oral medicine, a British surgeon named Jonathan Hutchinson. I've drawn down here normal teeth. Here are your central incisors, your lateral incisors, and then your canine is going back that way. What you'll see with Hutchinson's teeth, and I'll try and draw it here, is that the central incisors will be notched. You'll see notches here and they may even be widely spaced. So you'll have these notched central incisors or these notched central teeth. And beyond that, Dr. Hutchinson also described this very characteristic triad of late congenital syphilis. This triad that included three symptoms that were very characteristic of late congenital syphilis. Those three symptoms included Hutchinson's teeth and then interstitial keratitis. Interstitial keratitis, which is a result of the inflammation from white blood cells fighting the trepanemes in the eye. Most specifically around the cornea. And so you'll see some reddening and then over time, it'll affect the cornea and start to cause blindness. The other issue you can have is the nerve that's supposed to help us hear. This is referred to as the auditory nerve. This is the auditory nerve. And this of course also has blood vessels, so I'll draw a quick little blood vessel right here, that's supposed to supply oxygen to it. Well, because syphilis likes to target blood vessels, if it attacks the blood vessels that supply nutrients and oxygen to the auditory nerve, you can get the last of the three symptoms associated with Hutchinson's triad, which is deafness. >From talking about all these symptoms, I think that we can see that it's important to screen pregnant women for syphilis to prevent babies from being born with these symptoms or developing them later on.