Neglected Syphilis in Pregnancy Presenting as Condyloma Lata with Subsequent Congenital Syphilis: A Case Report.

Purpose: The likelihood of developing concurrent infections, such as bacterial vaginosis (BV) and sexually transmitted syphilis, tends to increase. Delayed diagnosis of maternal syphilis may allow progression to secondary syphilis and substantially increase the risk of vertical transmission. We report a neglected case of syphilis during pregnancy presenting as condyloma lata with concurrent bacterial vaginosis that subsequently resulted in congenital syphilis. Case Illustration: A 17-year-old married woman, gravida 1 para 0 abortus 0 (G1P0A0), at 34-35 weeks of gestation, presented with progressively enlarging vulvar warty lesions for three weeks and malodorous vaginal discharge for one month. Physical examination demonstrated multiple confluent yellowish-white plaques involving both labia majora and the vaginal introitus, consistent with condyloma lata. Serological screening showed reactive TPHA and VDRL with non-reactive HIV and HBsAg. She was diagnosed with secondary syphilis presenting as condyloma lata, bacterial vaginosis, urinary tract infection, and premature uterine contractions. Treatment consisted of intramuscular benzathine penicillin G (2.4 million units) and oral metronidazole (2 g). Because labor progressed with extensive vulvovaginal lesions, an emergency cesarean section was performed. The newborn had reactive TPHA and VDRL and was diagnosed with congenital syphilis despite the absence of overt clinical manifestations. Conclusion: This case highlights that delayed antenatal syphilis screening and late maternal treatment may allow progression to secondary syphilis with condyloma lata and increase the risk of congenital syphilis. Early screening and timely treatment are essential to prevent vertical transmission.