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50 Years Ago in THE JOURNAL OF PEDIATRICS

Congenital Syphilis: A Laid Ghost Walks
Woody NC, Sistrunk WF, Platou RV. J Pediatr 1964; 64:63-67

W oody et al describe 4 infants with congenital syphilis. The authors express concern that the falling incidence
of this infection had rendered house staff unable to readily diagnose it. Some of the offered pearls are a bit over-
stated in the context of today’s medicine—for example, the article quotes this “old clinical aphorism: suspect venereal
disease in .the tattooed man.” By and large, however, the article provides a serviceable overview, as the babies dis-
played many of the protean characteristics of congenital syphilis, including rash, snuffles, anemia, lymphadenopathy,
and periostitis.
The first recorded outbreak of syphilis occurred in 1495 among French troops laying siege to Naples, and from there
it spread rapidly throughout Europe, with many countries blaming their rival neighbors for its origin. In reality, it is
likely that this dreadful disease was imported to Europe from the New World by Christopher Columbus’ crew
members. The infection remained unabated for centuries and was not contained in the industrialized world until
the introduction of penicillin after World War II, after which there was a dramatic drop in new cases. In 1999,
with US incidence at a historic nadir, the Centers for Disease Control and Prevention (CDC) announced a strategic
plan to eliminate syphilis from the country altogether. Despite this, national incidence rates increased again during the
first decade of the new millennium, largely among gay men. During the same decade, however, the annual number of
cases of congenital syphilis reported to the CDC stayed relatively even, ranging between the high 300s and the mid
400s, a far cry from the 17 600 babies identified when national statistic were first collected in 1941 and the approximate
4000 figure when the article by Woody et al was published. Is the end of syphilis indeed near, at least in the US? Perhaps
a more durable medical aphorism than the one quoted above is that sexually transmitted infections are extraordinarily
hard to completely control, and in 2006 the CDC reframed the eradication plan, implying that it will be a long, gradual
process. Hence, it is probable that house staff in 2014 still will encounter the occasional infant with symptomatic
congenital syphilis, but that rapid recognition will continue to be confounded by its rarity and its multifarious
manifestations.

Philip Toltzis, MD
Hadassah Medical Center
Jerusalem, Israel
http://dx.doi.org/10.1016/j.jpeds.2013.08.008

66 Bizzarro, Ehrenkranz, and Gallagher