A Public Health Scourge: The Recent Surge of an Ancient Disease

The recent resurgence of congenital syphilis is striking, with an increase in cases 10-fold over the past 12 years, including a 30% rise within the past 3 years alone. The consequences of untreated maternal syphilis can be severe, contributing to significant fetal and neonatal illness and death in cases of congenital syphilis. We present a case involving a male fetus delivered stillborn at 33 weeks' gestation to a 30-year-old woman with limited prenatal care. The mother had been diagnosed with late latent syphilis 8 days before delivery and had a history of polysubstance use. Ultrasound at 32 weeks and 5 days revealed intrauterine fetal demise. Fetal measurements corresponded to approximately 27 weeks' gestation and demonstrated significant hydrops. Postmortem examination showed maceration, enlarged placenta, and focal necrotizing funisitis. Additional findings included arteritis of chorionic plate vessels and placental changes consistent with maternal vascular malperfusion. Radiographic evaluation identified lucent metaphyseal bands in the long bones. Immunohistochemical staining detected spirochetal organisms within the lung and placenta tissues. This case highlights the profound clinical implications of congenital syphilis and reinforces the necessity of consistent prenatal screening and prompt treatment of maternal infection.