{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T12:45:45Z","timestamp":1770554745644,"version":"3.49.0"},"reference-count":31,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,10,1]]},"abstract":"<jats:p>Congenital syphilis (CS) is a preventable infection, yet the incidence has surged to the highest rates in 20 years. Because 50% of live-born infants with CS are asymptomatic at birth, there is an increasing likelihood that pediatric providers will encounter older infants whose diagnoses were missed at birth, emphasizing the importance of timely prenatal screening and treatment. We present one such case of an infant admitted twice at 3 and 4 months of age with long bone fractures and suspected nonaccidental trauma. On her second presentation, several additional symptoms prompted evaluation for and eventual diagnosis of CS. In this case, it is demonstrated that an isolated long bone fracture can be a first presentation of CS, with other classic findings possibly appearing later. Pediatric providers should be familiar with the varied presentations of CS in older children, including the radiographic findings that we describe. The rising rates of CS reveal deficiencies in our current strategy to prevent CS and, thus, we recommend reconsideration of universal syphilis screening in the third trimester and at delivery, with timely treatment to prevent CS during pregnancy.<\/jats:p>","DOI":"10.1542\/peds.2019-1564","type":"journal-article","created":{"date-parts":[[2019,9,19]],"date-time":"2019-09-19T12:25:13Z","timestamp":1568895913000},"source":"Crossref","is-referenced-by-count":14,"title":["Congenital Syphilis Misdiagnosed as Suspected Nonaccidental Trauma"],"prefix":"10.1542","volume":"144","author":[{"given":"Kimberley","family":"Jacobs","sequence":"first","affiliation":[{"name":"aLucile Packard Children\u2019s Hospital, Palo Alto, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David M.","family":"Vu","sequence":"additional","affiliation":[{"name":"aLucile Packard Children\u2019s Hospital, Palo Alto, California;"},{"name":"bSanta Clara Valley Medical Center, San Jose, California; and"},{"name":"cSchool of Medicine, Stanford University, Stanford, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vidya","family":"Mony","sequence":"additional","affiliation":[{"name":"bSanta Clara Valley Medical Center, San Jose, California; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elvera","family":"Sofos","sequence":"additional","affiliation":[{"name":"bSanta Clara Valley Medical Center, San Jose, California; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadav","family":"Buzi","sequence":"additional","affiliation":[{"name":"bSanta Clara Valley Medical Center, San Jose, California; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2019,10,1]]},"reference":[{"issue":"3","key":"2025062311031826000_B1","doi-asserted-by":"crossref","first-page":"381.e1","DOI":"10.1016\/j.ajog.2015.10.007","article-title":"Congenital syphilis: trends in mortality and morbidity in the United States, 1999 through 2013","volume":"214","author":"Su","year":"2016","journal-title":"Am J Obstet Gynecol"},{"key":"2025062311031826000_B2","volume-title":"Sexually Transmitted Disease Surveillance 2017","author":"Centers for Disease Control and Prevention","year":"2018"},{"issue":"44","key":"2025062311031826000_B3","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.15585\/mmwr.mm6444a3","article-title":"Increase in incidence of congenital syphilis - United States, 2012-2014","volume":"64","author":"Bowen","year":"2015","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2025062311031826000_B4","volume-title":"Syphilis Surveillance Supplement 2013\u20132017","author":"Centers for Disease Control and Prevention","year":"2019"},{"issue":"1","key":"2025062311031826000_B5","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1097\/AOG.0000000000003000","article-title":"National trends and reported risk factors among pregnant women with syphilis in the United States, 2012-2016","volume":"133","author":"Trivedi","year":"2019","journal-title":"Obstet Gynecol"},{"issue":"39","key":"2025062311031826000_B6","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.15585\/mmwr.mm6739a3","article-title":"Factors contributing to congenital syphilis cases - New York City, 2010-2016","volume":"67","author":"Slutsker","year":"2018","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"1","key":"2025062311031826000_B7","first-page":"5","article-title":"Efficacy of treatment for syphilis in pregnancy","volume":"93","author":"Alexander","year":"1999","journal-title":"Obstet Gynecol"},{"key":"2025062311031826000_B8","first-page":"773","volume-title":"Red Book: 2018 Report of the Committee on Infectious Diseases","author":"American Academy of Pediatrics","year":"2018"},{"issue":"5","key":"2025062311031826000_B9","doi-asserted-by":"crossref","DOI":"10.1542\/peds.109.5.e79","article-title":"Mortality associated with congenital syphilis in the United States, 1992-1998","volume":"109","author":"Gust","year":"2002","journal-title":"Pediatrics"},{"issue":"3","key":"2025062311031826000_B10","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1053\/j.semperi.2018.02.005","article-title":"Congenital syphilis","volume":"42","author":"Cooper","year":"2018","journal-title":"Semin Perinatol"},{"issue":"4","key":"2025062311031826000_B11","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1053\/j.spid.2005.06.005","article-title":"Syphilis in children: congenital and acquired","volume":"16","author":"Woods","year":"2005","journal-title":"Semin Pediatr Infect Dis"},{"issue":"5","key":"2025062311031826000_B12","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1302\/0301-620X.71B5.2584243","article-title":"The skeletal manifestations of congenital syphilis. 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