Congenital syphilis: when the medium fails to transmit the message

To report two cases of congenital syphilis, a disease which should have been prevented.

Two infants, both from the country, presented to Princess Margaret Hospital for Children. Case 1, a boy of five months, had unexplained fractures of radius and clavicle, suggesting non-accidental injury, a belief which lasted until skeletal survey showed widespread bone disease. Exact diagnosis became clear after serological studies. Case 2, an Aboriginal baby of six weeks, came with more classic symptoms and signs--rhinorrhea, rash with desquamation, irritability, anaemia, and lack of movement in an upper limb; the serological diagnosis already made.

Both infants (and their mothers) were treated with appropriate antibiotics and the symptoms resolved.

The first case was a challenge to the system for handling suspected child abuse; the second will be a challenge to the follow-up system in a remote area of Western Australia. The delay in diagnosis occurred because the results of the serological tests for syphilis were not appreciated and acted upon. The reports have become complex, consisting of acronyms and numbers which do not convey meaning to clinicians who receive them. Each report should translate the terms and endeavour to interpret the results, to aid prevention of congenital syphilis in the antenatal period or to give early diagnosis and accurate, efficient treatment of the affected infant.