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Ans. c. Congenital syphilis Clinical Presentation of Syphilis Early Congenital Syphilis: Snuffles (rhinitis)Q is earliest feature. Lesions are vesicobullousQ, and snail track ulcers on mucosa Clinical Presentation of Syphilis Late Congenital Syphilis: Characterized by Hutchinson's triad (interstitial keratitis + 8th nerve deafness + Hutchinson's teeth i.e. pegged central upper incisors)Q Saddle nose, sabre tibia, mulberry molarsQ Bull dog's jaw (protrusion of jaw) Rhagadesdeg (linear fissure at mouth, nares) Frontal bossing, hot cross bun deformity of skull Clutton's jointdeg (painless swelling of joints, most commonly both knee) Palatal perforationdeg Higaumenakis sign (periostitis leads to unilateral enlargement of sterna end of clavicle) Primary Syphilis: Painless, indurated, nonbleeding, usually single punched out ulcer (hard chancre)Q Painless, rubbery shotty lymphadenopathy Secondary Syphilis: Bilateral symmetrical asymptomatic localized or diffuse mucocutaneous lesiondeg (macule, papule, paulosquamous and rarely pustule) Non-tender generalized lymphadenopathyQ Highly infectious condylomata late, in warm moist interiginous areas Moth eaten alopecia, ahritis, proteinuriaQ Teiary Syphilis: Gumma, neurosyphilis/tabes dorsalisQ Ostitis, periostitis Aoitis, aoic insufficiency, coronary stenosis and nocturnal anginaQ