Objective: To report two cases of congenital syphilis, a disease which
should have been prevented. Clinical features: Two infants, both from
the country, presented to Princess Margaret Hospital for Children. Ca
se 1, a boy of five months, had unexplained fractures of radius and cl
avicle, 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 we
eks, 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. Intervention and outcom
e: Both infants (and their mothers) were treated with appropriate anti
biotics and the symptoms resolved. Conclusions: The first case was a c
hallenge to the system for handling suspected child abuse; the second
will be a challenge to the follow-up system in a remote area of Wester
n Australia. The delay in diagnosis occurred because the results of th
e serological tests for syphilis were not appreciated and acted upon.
The reports have become complex, consisting of acronyms and numbers wh
ich 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 gi
ve early diagnosis and accurate, efficient treatment of the affected i
nfant.