CONGENITAL-SYPHILIS - WHEN THE MEDIUM FAILS TO TRANSMIT THE MESSAGE

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.