{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T09:13:49Z","timestamp":1784193229812,"version":"3.55.0"},"reference-count":22,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1999,1,1]]},"abstract":"<jats:p>Syphilis in preschoolers is rarely described in current medical literature, despite the rise in syphilis in both the adult and the pediatric populations during the past decade. Since that time, 3 children between 3 and 4 years of age have been diagnosed with syphilis at the Children's Hospital of Philadelphia. The presentations and clinical manifestations of syphilis in these 3 children are described, and the difficulty in identifying the source of infection is discussed. The presentations of these children included nephrosis and secondary syphilis, the corymbiform and palmar rash of syphilis, and subtle signs of late congenital infection in an otherwise asymptomatic child. One child had documented congenital infection, 1 had probable congenital infection that went untreated, and 1 did not have appropriate neonatal testing documented. None of the children gave a verbal history of sexual abuse, although it is likely that all three cases resulted from sexual abuse. The evaluation of preschool children with syphilis is confounded by the interpretation of acquired infection in consideration of a history of possible or documented congenital disease. The assessment is complicated further by problems with recognition of clinical disease, the inability of young children to provide a history, prenatal and neonatal testing methods used, changes in treatment recommendations made during the past decade, and inadequate follow-up to document cure of congenitally infected infants. With the increase in syphilis seen in recent years, physicians are more likely to encounter preschoolers with syphilis. Our ability to document acquired infection, however, is hampered by the difficulties encountered in following recommended guidelines for evaluation and follow-up and by limitations in interviewing young victims of sexual abuse, which may impair our ability to protect children from additional harm. Understanding the pathophysiology and progression of this disease remains challenging even in this modern era.<\/jats:p>","DOI":"10.1542\/peds.103.1.e4","type":"journal-article","created":{"date-parts":[[2004,8,13]],"date-time":"2004-08-13T23:45:45Z","timestamp":1092440745000},"page":"e4-e4","source":"Crossref","is-referenced-by-count":29,"title":["Preschoolers With Syphilis"],"prefix":"10.1542","volume":"103","author":[{"given":"Cindy W.","family":"Christian","sequence":"first","affiliation":[{"name":"From the Divisions of General Pediatrics,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Lavelle","sequence":"additional","affiliation":[{"name":"Emergency Medicine, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis M.","family":"Bell","sequence":"additional","affiliation":[{"name":"Emergency Medicine, and"},{"name":"Immunologic and Infectious Diseases, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[1999,1,1]]},"reference":[{"key":"2021121022251165100_B1","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/S0891-5520(20)30422-0","article-title":"Resurgence of congenital syphilis.","volume":"6","author":"Berry","year":"1992","journal-title":"Infect Dis Clin North Am."},{"key":"2021121022251165100_B2"},{"key":"2021121022251165100_B3","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1097\/00006454-198305000-00012","article-title":"Acquired syphilis in prepubertal children.","volume":"2","author":"Ginsburg","year":"1983","journal-title":"Pediatr Infect Dis J."},{"key":"2021121022251165100_B4","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1542\/peds.49.2.260","article-title":"The nephrotic syndrome in congenital syphilis: an immunopathy.","volume":"49","author":"Hill","year":"1972","journal-title":"Pediatrics."},{"key":"2021121022251165100_B5","first-page":"1","article-title":"Clinical syphilitic nephropathies.","volume":"19","author":"Herrmann","year":"1935","journal-title":"Am J Syphilis Neurol."},{"key":"2021121022251165100_B6","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1056\/NEJM197502272920903","article-title":"Immunopathogenesis of syphilitic glomerulonephritis. Elution of antitreponemal antibody from glomerular immune-complex deposits.","volume":"292","author":"Gamble","year":"1975","journal-title":"N Engl J Med."},{"key":"2021121022251165100_B7"},{"key":"2021121022251165100_B8","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1097\/00006454-199211110-00008","article-title":"Epidemiology of adult sexually transmitted disease agents in children being evaluated for sexual abuse.","volume":"11","author":"Ingram","year":"1992","journal-title":"Pediatr Infect Dis J."},{"key":"2021121022251165100_B9","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/0145-2134(90)90088-B","article-title":"Syphilis as a sole indicator of sexual abuse: two cases with no intervention.","volume":"14","author":"Horowitz","year":"1990","journal-title":"Child Abuse Negl."},{"key":"2021121022251165100_B10"},{"key":"2021121022251165100_B11","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1016\/0145-2134(96)00100-7","article-title":"Outcome-based practice: disclosure rates of child sexual abuse comparing allegation blind and allegation informed structured interviews.","volume":"20","author":"Cantlon","year":"1996","journal-title":"Child Abuse Negl."},{"key":"2021121022251165100_B12","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/0145-2134(96)88716-3","article-title":"Sexual abuse evaluations in the emergency department: is the history reliable?","volume":"20","author":"Gordon","year":"1996","journal-title":"Child Abuse Negl."},{"key":"2021121022251165100_B13","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1097\/00006454-199107000-00008","article-title":"Congenital syphilis: trends and recommendations for evaluation and management.","volume":"10","author":"Zenker","year":"1991","journal-title":"Pediatr Infect Dis J."},{"key":"2021121022251165100_B14","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1542\/peds.91.1.88","article-title":"Comparison of maternal sera, cord blood, and neonatal sera for detecting presumptive congenital syphilis: relationship with maternal treatment.","volume":"91","author":"Chhabra","year":"1993","journal-title":"Pediatrics."},{"key":"2021121022251165100_B15"},{"key":"2021121022251165100_B16"},{"key":"2021121022251165100_B17","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1056\/NEJM197405162902005","article-title":"Acquired syphilis in three patients with congenital syphilis.","volume":"290","author":"Fiumara","year":"1974","journal-title":"N Engl J Med."},{"key":"2021121022251165100_B18"},{"key":"2021121022251165100_B19"},{"key":"2021121022251165100_B20"},{"key":"2021121022251165100_B21","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1016\/S0022-3476(05)83151-8","article-title":"Concentrations of procaine and aqueous penicillin in the cerebrospinal fluid of infants treated for congenital syphilis.","volume":"124","author":"Azimi","year":"1994","journal-title":"J Pediatr."},{"key":"2021121022251165100_B22","first-page":"240","article-title":"Does early treatment prevent dental changes in congenital syphilis?","volume":"43","author":"Putkonen","year":"1963","journal-title":"Acta Dermato-Venereologica."}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/103\/1\/e4\/841041\/e4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/103\/1\/e4\/841041\/e4.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,29]],"date-time":"2023-04-29T05:35:03Z","timestamp":1682746503000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/103\/1\/e4\/62086\/Preschoolers-With-Syphilis"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1999,1,1]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[1999,1,1]]},"published-print":{"date-parts":[[1999,1,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.103.1.e4","relation":{},"ISSN":["1098-4275","0031-4005"],"issn-type":[{"value":"1098-4275","type":"electronic"},{"value":"0031-4005","type":"print"}],"subject":[],"published":{"date-parts":[[1999,1,1]]}}}