• Irritability
• Failure to gain weight or failure to thrive
• Watery discharge from the nose
• Early rash
  • Small blisters (vesicles) on the palms and soles
• Later rash
  • Copper-colored, flat or bumpy (maculopapular) rash on the face, palms, soles
• Rash at the junction of the skin and mucus membranes of the mouth, genitalia, and anus
• No bridge to nose (saddle nose)

• Bone pain
• Refusal to move a painful extremity
• Saber shins (bone abnormality of the lower leg)
• Joint swelling (joint effusion)
• Abnormal teeth (notched and peg shaped -- called Hutchinson teeth)
• Scarring of the skin around earlier lesions on the mouth, genitalia, and anus (called rhagades)
• Visual loss
• Clouding of the cornea
• Decreased hearing or deafness
• Gray, mucous-like patches on the anus and outer vagina (condyloma lata)

The physical examination may show signs of bone inflammation (periosteal elevations or osteochondritis). There may be evidence of hepatomegaly (enlarged liver) and splenomegaly (enlarged spleen).

Tests on the mother may include:

• VDRL
• FTA-ABS fluorescent treponemal antibody test

If the disorder is suspected at the time of birth, the placenta will be examined for signs of syphilis.

• On an older infant or child may include:
  
  • Serologic test for syphilis (VDRL and FTA-ABS)
  • Lumbar puncture to look for evidence of syphilis in the brain and central nervous system
  • Microscopy, dark field examination (demonstrates Treponema pallidum)
  • X-ray of the bone(s)