Gross findings in the stillborn fetus:
(1) maceration
(2) mucocutaneous lesions (bullae, vesicles, superficial desquamation, petechiae, papulosquamous lesions, mucous patches, and condylomata lata)
(3) hepatosplenomegaly
(4) lymphadenopathy
(5) hydrops fetalis
(6) large placenta for gestational age with plasma cell inflammation
X-rays of the long bones may suggest the diagnosis:
(1) osteochondritis
(2) osteitis
(3) periostitis
Diagnostic findings:
(1) positive serologic tests for syphilis in the mother
(2) demonstration of spirochetes (4 to 10 microns long with a diameter of 0.5 microns) in the fetal liver, amniotic fluid or skin lesions
(3) positive PCR or other amplification technique
Limitations:
• Silver stains for identifying spirochetes can be technically challenging. They require some experience and very clean glassware. Immunoperoxidase stains probably will supplant these stains in the future.
• Antibiotic therapy may cause disappearance or damage to spirochetes.
