In utero infection by the spirochete Treponema pallidum can occur after the 16th week of gestation. Intrauterine disease, especially during early pregnancy, may result in spontaneous abortion or in a severely affected infant. Severe disease that is present at birth presents with hepatosplenomegaly, ascites, meningoencephalitis, and severe anemia. Osteochondritis is the most characteristic bone change. The cutaneous findings in severe congenital syphilis include bullae, pustules, macules, and papules. Fissuring and peeling of the skin are also characteristic. The palms, soles, and periorificial skin are sites of predilection. Syphilitic rhinitis, with a copious and bloody nasal discharge, is an associated finding. If infection occurs late in pregnancy, signs and symptoms may be delayed for several weeks. In these cases, diagnosis is usually made on the basis of a positive syphilis serology in mother and infant. If the disease is allowed to progress, rhinitis, cutaneous macules, and mucous patches may be the presenting signs.