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Fig 1.

Number of congenital syphilis cases.

Histogram shows registered cases by year.

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Fig 2.

Timeline of the age at diagnosis.

Bar chart shows the number of patients diagnosed at different ages and the period of early and late congenital syphilis.

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Fig 3.

Representative radiological images of bone involvement and Hutchinson's teeth findings.

(A) Posteroanterior radiographs of a female newborn showing, at the left, humerus with diffuse periosteal reaction (arrow) and, in the right, lytic image in the distal region of left tibia (arrow). (B) Posteroanterior radiograph of a male newborn showing lytic image in the proximal region of the right tibia and fibula. (C) Hutchinson's teeth in a 2- years old girl (D) Posteroanterior radiographs showing widespread periostitis of the humerus (arrow), at the left, and tibia at the right (arrow) in a 2- years old girl.

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Fig 4.

Dermatological findings.

(A) Pictures demonstrating maculopapular rash on the palms (upper panel) and soles (lower panel) of a 4-month-old boy. (B) Improvement of the lesions two days after penicillin treatment in the same patient.

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Table 1.

Demographic and clinical findings at diagnosis.

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Table 2.

Complementary studies at diagnosis.

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Table 3.

Comparative nontreponemal testing (Child vs mother).

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Fig 5.

Representative radiological images of the bone lesions evolution after treatment.

(A) Posteroanterior radiographs of a 14 month-old girl showing, at the left, diffuse periosteal reaction in the humerus (arrow) and in the right, periosteal reaction in tibia and fibula (arrow) (B) Improvement of the lesions after treatment.

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Fig 6.

Bone sequelae: Radiological images and pictures of one patient.

(A) Posteroanterior radiograph taken of a 3 years-old girl showing pseudarthrosis of the right elbow (arrow) with absence of distal metaphyseal ossification of the humerus and radio-ulnar osteoporosis. (B) Bone deformities (arrow) involving the junction of the right arm (C) Bone deformities (arrow) involving the junction of the left leg with severe anterolateral bowing of the limb (D) Lateral view radiograph showing left knee pseudoarthrosis (arrow) with lack of ossification of the proximal and distal metaphysis of the femur and distal tibia and fibula osteoporosis.

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Fig 7.

Serological follow-up in 30 congenital syphilis treated patients.

Figure shows log titers of RPR changes over time. Dark blue line represents the smooth regression of the data. Red horizontal line represents the cut value.

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