Worrying increase in the risk of vertical transmission of syphilis in Croatia, 2020 to 2024.

Four infants potentially exposed to syphilis infection in utero, meeting World Health Organization surveillance criteria of congenital syphilis (CS), were diagnosed in Croatia between September 2020 and January 2024. We conducted a retrospective analysis of epidemiological, clinical and laboratory data of these cases to assess compliance with surveillance case definitions. As only one confirmed CS case has been reported in Croatia in over 2 decades, these reports signal an increased risk of syphilis vertical transmission and warrant strengthening antenatal screening.

Missed opportunities for prevention of congenital syphilis.

BACKGROUND: The WHO presented the initiative: "Global elimination of congenital syphilis (CS): rationale and strategies for action". It establishes that CS is a preventable disease that can be eliminated. OBJECTIVE: To estimate the proportion of missed opportunities for prevention (MOP) of (CS). MATERIAL AND METHODS: Cross-sectional study. We studied women with children with confirmed diagnosis of CS (NOM-039-SSA2-2002) in the Mexican Social Security Institute in Jalisco from 01/01/2016 to 08/01/2022. The clinical records of the mother, the newborn and the epidemiological study (ES) were reviewed. Each case was classified into one of the MOP categories. RESULTS: 52 cases were reported: 46.2 % (n = 24) were ruled out, 34.6 % (n = 18) confirmed, 15.4 % (n = 8) unknown and 3.8 % (n = 2) probable cases. The HIV test was performed in 61.1 % (n = 11) and syphilis in 72.2 % (n = 13) of the mothers. The MOP in 27.8 % (n = 5) was inadequate treatment or omission of maternal treatment despite a timely diagnosis of syphilis. Treatment was inadequate in 63.6 % (n = 7) of the women who received it. CONCLUSION: The classification of MOP identifies gaps in CS prevention and can guide stakeholders, policy makers and public health prevention programs to reduce the incidence of CS.

ANTECEDENTES: La Organización Mundial de la Salud estableció que la sífilis congénita es una enfermedad prevenible que puede eliminarse. OBJETIVO: Estimar la proporción de oportunidades perdidas en la prevención (OPP) de la sífilis congénita. MATERIAL Y MÉTODOS: Estudio transversal descriptivo. Se eligieron mujeres en cuyos hijos recién nacidos se identificó sífilis congénita entre 2016 y 2022. Se revisaron los expedientes clínicos de la madre, el recién nacido y el estudio epidemiológico. Cada caso se clasificó en una de las categorías de las OPP. RESULTADOS: Se notificaron 52 casos: 46.2 % (n = 24) fue descartado, 34.6 % (n = 18) confirmado, 15.4 % (n = 8) desconocido y 3.8 % (n = 2) probable. Las pruebas para identificar infección por VIH y sífilis se realizaron en 61.1 % (n = 11) y 72.2 % de las madres (n = 13). La OPP en 27.8 % (n = 5) consistió en el tratamiento inadecuado u omisión de tratamiento materno a pesar de diagnóstico oportuno de la sífilis. De quienes recibieron tratamiento, en 63.6 % fue inadecuado (n = 7). CONCLUSIÓN: La clasificación de OPP de sífilis congénita permite identificar brechas en la prevención y dirigir intervenciones de salud pública hacia las principales causas para reducir la incidencia.

Increase in congenital syphilis in a tertiary-care centre from Madrid, Spain: Back to the classics.

Globally, an increase in sexually transmitted diseases worldwide has been reported, including acquired Treponema pallidum infection. Congenital syphilis is the mother-to-child transmission syphilis infection, experiencing an increase in cases returning to incidence rates of years ago. We report three cases of symptomatic congenital syphilis occurring in a tertiary-care hospital in Madrid (Spain). Cases were diagnosed by serology and molecular biology methods. The use of molecular techniques in specimens such as skin lesion, subplacental exudate swabs, bronchoalveolar aspirate, or cerebrospinal fluid could favour the diagnosis of this clinical entity, especially in symptomatic newborns with systemic involvement.

Notification rates for syphilis in women of reproductive age and congenital syphilis in Australia, 2011-2021: a retrospective cohort analysis of national notifications data.

OBJECTIVES: To estimate notification rates for infectious syphilis in women of reproductive age and congenital syphilis in Australia. STUDY DESIGN: Retrospective cohort study; analysis of national infectious syphilis and enhanced congenital syphilis surveillance data. SETTING, PARTICIPANTS: Women aged 15-44 years diagnosed with infectious syphilis, and babies with congenital syphilis, Australia, 2011-2021. MAIN OUTCOME MEASURES: Numbers and rates of infectious syphilis notifications, by Indigenous status and age group; numbers and rates of congenital syphilis, by Indigenous status of the infant; antenatal care history for mothers of infants born with congenital syphilis. RESULTS: During 2011-2021, 5011 cases of infectious syphilis in women aged 15-44 years were notified. The notification rate for Aboriginal and Torres Strait Islander women rose from 56 (95% confidence interval [CI], 45-65) cases per 100 000 in 2011 to 227 (95% CI, 206-248) cases per 100 000 population in 2021; for non-Indigenous women, it rose from 1.1 (95% CI, 0.8-1.4) to 9.2 (95% CI, 8.4-10.1) cases per 100 000 population. The notification rate was higher for Aboriginal and Torres Strait Islander women than for non-Indigenous women (incidence rate ratio [IRR], 23.1; 95% CI, 19.7-27.1), lower for 15-24- (IRR, 0.7; 95% CI, 0.6-0.9) and 35-44-year-old women (IRR, 0.6; 95% CI, 0.5-0.7) than for 25-34-year-old women, and higher in remote regions than in major cities (IRR, 2.7; 95% CI, 2.2-3.8). During 2011-2021, 74 cases of congenital syphilis were notified, the annual number increasing from six in 2011 to a peak of 17 in 2020; the rate was consistently higher among Aboriginal and Torres Strait Islander infants than among non-Indigenous infants (2021: 38.3 v 2.1 per 100 000 live births). The mothers of 32 infants with congenital syphilis (43%) had not received antenatal care. CONCLUSIONS: The number of infectious syphilis notifications for women of reproductive age increased in Australia during 2011-2021, as did the number of cases of congenital syphilis. To avert congenital syphilis, antenatal screening of pregnant women, followed by prompt treatment for infectious syphilis when diagnosed, needs to be improved.

Spatiotemporal Bayesian modeling of the risk of congenital syphilis in São Paulo, SP, Brazil.

The aim of this study is to analyze the spatiotemporal risk of congenital syphilis (CS) in high-prevalence areas in the city of São Paulo, SP, Brazil, and to evaluate its relationship with socioeconomic, demographic, and environmental variables. An ecological study was conducted based on secondary CS data with spatiotemporal components collected from 310 areas between 2010 and 2016. The data were modeled in a Bayesian context using the integrated nested Laplace approximation (INLA) method. Risk maps showed an increasing CS trend over time and highlighted the areas that presented the highest and lowest risk in each year. The model showed that the factors positively associated with a higher risk of CS were the Gini index and the proportion of women aged 18-24 years without education or with incomplete primary education, while the factors negatively associated were the proportion of women of childbearing age and the mean per capita income.

Detection of gestational and congenital syphilis in Paraná state, Brazil, 2007-2021: a time series analysis.

OBJECTIVE: To describe temporal trends in the detection rates of gestational and congenital syphilis, by maternal age and health macro-region of the state of Paraná, Brazil, 2007-2021. METHODS: This was a time-series study using surveillance data; the trend analysis was performed by means of joinpoint regression, and average annual percent change (AAPC) and 95% confidence intervals (95%CI) were estimated. RESULTS: An increase in statewide detection of gestational syphilis (AAPC = 21.7; 95%CI 17.7; 32.8) and congenital syphilis (AAPC = 14.8; 95%CI 13.0; 19.7) was found; an increase was also found in the health macro-regions, with the Northwest (gestational, AAPC = 26.1; 95%CI 23.4; 31.6) and North (congenital, AAPC = 23.8; 95%CI 18.8; 48.9) macro-regions standing out; statewide rising trends were observed for young women [gestational, AAPC = 26.2 (95%CI 22.4; 40.6); congenital, AAPC = 19.4 (95%CI 17.6; 21.8)] and adult women [gestational, AAPC = 21.3 (95%CI 16.9; 31.9); congenital, AAPC = 13.7 (95%CI 11.9; 19.3)]. CONCLUSION: Maternal and child syphilis detection rates increased in the state, regardless of maternal age and health macro-region. MAIN RESULTS: Increasing trends were found for the detection rates of gestational and congenital syphilis in Paraná state and its health macro-regions, including in the analysis stratified by maternal age group; however, there was a decline during the COVID-19 period. IMPLICATIONS FOR SERVICES: There is a need for strategic and immediate action by the state health services, focusing on expanding access and linkage to care, in order to ensure maternal and child well-being and reverse the rising trends observed. PERSPECTIVES: Prevention and control actions towards the elimination of syphilis are needed to overcome these obstacles, directing efforts towards strengthening health education, early detection and appropriate treatment for pregnant women and their partners.

Resurgent Maternal and Congenital Syphilis in Mississippi-Pathways for Prevention.

This Viewpoint discusses Mississippi's public health challenges particularly as they relate to resurgent maternal and congenital syphilis.

The Epidemic of Congenital Syphilis in the Indigenous and Rural Populations of South Dakota.

From 2020 to 2023, South Dakota witnessed a substantial increase in cases of congenital syphilis (CS), with the highest rates identified in rural and Native American (NA) communities. Here, we discuss 3 severe cases of CS in premature infants born to NA individuals and communities in South Dakota with poor access to prenatal care. The infants in these 3 cases presented with varying clinical conditions, including respiratory failure, persistent pulmonary hypertension of the newborn, severe direct hyperbilirubinemia, feeding intolerance, and necrotizing enterocolitis. Lack of prenatal care and other systemic health disparities likely contributed to the increased disease burden. For NA communities, rurality, limited resources, systemic racism, historical trauma, and lack of trust in medical institutions likely contribute to inadequate prenatal care. All 3 of these cases also occurred in pregnant people with a present or history of substance use disorders, which may have led to further hesitancy to seek care because of fear of prosecution. To combat the rising number of syphilis and CS cases, we advocate for new and continued outreach that provides education about and testing for sexually transmitted diseases to NA and rural populations, increased care coordination, the integration of point-of-care testing and treatment strategies in lower resource centers, and legislative allocation of additional resources to engage pregnant people with or at risk for substance use disorders.

A Review of Syphilis Infection in Pediatric Patients.

Nearly half of all sexually transmitted infections occur in adolescents and young adults. Among them, syphilis infections are on the rise in the United States. Sexually active adolescents, especially those who do not use condoms consistently or are men who have sex with men, are at particular risk for syphilis infection. With the rise in acquired syphilis infections, the incidence of congenital syphilis has also increased. Syphilis can have a variety of presentations based on infectious stage and central nervous system involvement. Careful physical examination and history can elicit the diagnosis. Screening with a nontreponemal test followed by treponemal testing can confirm the diagnosis, and staging is determined clinically. Testing for all sexually transmitted infections should be pursued because coinfections are common. Penicillin is the first-line treatment for syphilis, and duration of therapy depends on the presence of neurologic symptoms; all infants with possible congenital syphilis should receive treatment. Posttreatment monitoring is essential to confirm successful eradication of syphilis. All sexually active, at-risk patients, including pregnant persons, should be screened for syphilis, and those diagnosed as having syphilis should be counseled on disclosure to partners. Although not often found in a pediatric population, with the increasing incidence of syphilis infections in the United States, pediatric providers should have a low threshold for syphilis screening in adolescents and a high index of suspicion for congenital syphilis in infants.

Congenital Syphilis in Live Births: Adverse Outcomes, Hospital Length of Stay, and Costs.

OBJECTIVE: To examine temporal trends and risk factors for congenital syphilis in newborn hospitalizations and to evaluate the association between adverse outcomes and congenital syphilis and health care utilization for newborn hospitalizations complicated by congenital syphilis. METHODS: We conducted a retrospective, cross-sectional study using data from the National Inpatient Sample to identify newborn hospitalizations in the United States between 2016 and 2020. Newborns with congenital syphilis were identified with International Classification of Diseases, Tenth Revision, Clinical Modification codes. Adverse outcomes, hospital length of stay, and hospital costs were examined. The annual percent change was calculated to assess congenital syphilis trend. A multivariable Poisson regression model with robust error variance was used to examine the association between congenital syphilis and adverse outcomes. Adjusted relative risks (RRs) with 95% CIs were calculated. A multivariable generalized linear regression model was used to examine the association between congenital syphilis and hospital length of stay and hospital costs. Adjusted mean ratios with 95% CIs were calculated. RESULTS: Of 18,119,871 newborn hospitalizations in the United States between 2016 and 2020, the rate of congenital syphilis increased over time (annual percent change 24.6%, 95% CI, 13.0-37.3). Newborn race and ethnicity, insurance, household income, year of admission, and hospital characteristics were associated with congenital syphilis. In multivariable models, congenital syphilis was associated with preterm birth before 37 weeks of gestation (adjusted RR 2.22, 95% CI, 2.02-2.44) and preterm birth before 34 weeks of gestation (adjusted RR 2.39, 95% CI, 2.01-2.84); however, there was no association with low birth weight or neonatal in-hospital death. Compared with newborns without congenital syphilis, hospital length of stay (adjusted mean ratio 3.53, 95% CI, 3.38-3.68) and hospital costs (adjusted mean ratio 4.93, 95% CI, 4.57-5.32) were higher among those with congenital syphilis. CONCLUSION: Among newborn hospitalizations in the United States, the rate of congenital syphilis increased from 2016 to 2020. Congenital syphilis was associated with preterm birth, longer hospital length of stay, and higher hospital costs.

Congenital syphilis, syphilis in pregnancy and prenatal care in Brazil: An ecological study.

The aim of this research was to evaluate the incidence of congenital syphilis and the ratio between congenital syphilis and syphilis in pregnant women in Brazil according to socioeconomic indicators (inadequate water supply and sanitation; illiteracy at 15 years of age or older; household income per capita; proportion of poor people; Gini index; human development index; and average health expenditure per inhabitant by the health system) and prenatal quality-of-care indicators. We conducted an ecological study using a sample composed of 257 municipalities, each with ≥ 100,000 inhabitants. Data was collected from four public databases: the Brazilian Institute of Geography and Statistics, comprising socioeconomical data from the 2010 census; and the data of 2019 available in the databases of the Department of Informatics of the Brazilian Health System, Information and Management of Primary Care, and the Electronic Citizen Information System. Descriptive analysis of dependent and independent variables and bivariate analysis by Negative Binomial regression were carried out. The mean incidence of congenital syphilis was 38% higher in municipalities with a Human Development Index up to 0.785 (ratio of means [RM] = 1.38; p = 0.049) and 57% higher among populations where less than 50% of primary healthcare services provided a rapid test for syphilis (RM = 1.57; p < 0.001). The ratio between congenital syphilis and syphilis in pregnant women was 29% higher in municipalities with a low household income per capita (RM = 1.29; p < 0.001) and 28% higher in locations where less than 50% of the primary healthcare services provided a rapid test for syphilis (RM = 1.28; p < 0.001). There was no statistical significance of the quality of prenatal care compared to the outcomes. This result underscores the challenges in detecting syphilis infections among pregnant women during prenatal care, consequently increasing the risk of vertical transmission of the disease to the fetus. Traits of inequality in the occurrence of congenital syphilis also draw attention to strategies to reduce health inequities and improve prenatal care.

Epidemiology of Syphilis in Tokyo from 2019 to 2022: a Descriptive Epidemiological Study.

In recent years, the incidence of syphilis in Tokyo has increased. This descriptive epidemiological study aimed to elucidate the status of syphilis within the city. Data regarding age, sex, disease stage, and presumed sexual partners of patients with syphilis reported in Tokyo were compiled and analyzed. A total of 9,419 patients with syphilis were diagnosed between 2019 and 2022. A sharp rise was observed in the number of reported cases from 2021 to 2022. Between 2020 and 2022, the number of women in their 20s who developed syphilis rapidly increased by more than 3-fold. Furthermore, the number of pregnant women with syphilis increased the end of 2022. Despite a rapid increase in the number of young women with syphilis, the incidence of congenital syphilis has remained stable. This stability may be attributed to the early detection of syphilis during pregnancy, facilitated by the high rate of antenatal checkups in Tokyo. However, the growing incidence of syphilis among young women could potentially lead to a rise congenital syphilis cases in the future. Therefore, public health strategies should include educational initiatives targeting high-risk populations and adolescents, along with early and appropriate testing and treatment to prevent the progression of syphilis.

Syphilis Has Surged for Reasons That Go Beyond the Pathogen That Causes It.

This Medical News story discusses the multiple factors contributing to the resurgence of syphilis in the US.

Vigilância epidemiológica da sífilis: informe epidemiológico SE 01 a 24/2024 / Epidemiological surveillance of syphilis: epidemiological report SE 01 to 24/2024

Informe epidemiológico com dados da sífilis adquirida em gestantes e sífilis congênita no Estado de Goiás

Epidemiological report with data on acquired syphilis in pregnant women and congenital syphilis in the State of Goiás

Contribution of Syphilis to Adverse Pregnancy Outcomes in People Living With and Without HIV in South Brazil: 2008 to 2018.

BACKGROUND: Syphilis coinfection among pregnant people living with HIV (PLH) may worsen pregnancy outcomes. We evaluated the impact of syphilis coinfection on pregnancies in south Brazil. METHODS: Data were extracted from hospital records between January 1, 2008, and December 31, 2018. Preterm birth (PTB), low birth weight (LBW <2500 g), and a composite adverse infant outcome (AIO: HIV vertical transmission, loss to follow-up before HIV diagnosis, stillbirth, congenital syphilis) were evaluated among pregnancies without HIV and syphilis (PWOH + S), PLH monoinfection, syphilis monoinfection (PLS), and PLH with syphilis (PLH + S). RESULTS: Among 48,685 deliveries where patients were tested for HIV and syphilis, 1353 (2.8%) occurred in PLH; of these, 181 (13.4%) were HIV/syphilis coinfected (PLH + S). Among PLH, 2.4% of infants acquired HIV and 13.1% were lost to follow-up before HIV diagnosis. Among all PLS, 70.5% of infants acquired congenital syphilis. Across the cohort, 1.2% stillbirths/neonatal deaths occurred. Thirty-seven percent of PLH + S did not initiate antiretroviral therapy versus 15.4% of PLH monoinfection ( P < 0.001). Less than half (37.6%) of PLH + S had VDRL titers ≥1:16 compared with 21.7% of PLS only ( P < 0.001). Among PLH, syphilis coinfection and unknown/high VDRL titers (≥1:16) increased AIO risk more (adjusted relative risk [aRR], 3.96; 95% confidence interval [CI], 3.33-4.70) compared with low VDRL titers (≤1:8; aRR, 3.51; 95% CI, 2.90-4.25). Unsuppressed viremia (≥50 copies/mL) was associated with risk of PTB (aRR, 1.43; 95% CI, 1.07-1.92) and AIO (aRR, 1.38; 95% CI, 1.11-1.70) but not LBW. Lack of prenatal care was significant in predicting PTB and LBW in all PLH and PLS monoinfection. CONCLUSIONS: Syphilis coinfection worsens AIOs in all women and compounds negative effects of HIV infection during pregnancy. Effective syphilis treatment and HIV viral load suppression are paramount for optimal obstetric care.

Social Factors Associated With Congenital Syphilis in Missouri.

BACKGROUND: Congenital syphilis disproportionately affects individuals impacted by adverse social determinants of health. Understanding these determinants may help facilitate holistic care. METHODS: We performed a retrospective review of mother-infant dyads with potential congenital syphilis in a Missouri hospital system. Cases were classified per Centers for Disease Control and Prevention clinical scenarios. Information was collected regarding demographics, prenatal care, substance use, and other social factors. Dyads with confirmed/highly probable or possible congenital syphilis ("congenital syphilis outcomes") were compared to those with less likely/unlikely congenital syphilis ("noncongenital syphilis outcomes") using descriptive statistics. RESULTS: We identified 131 dyads with infant dates of birth from 2015 to 2022: 74 (56%) with congenital syphilis outcomes and 56 (43%) with noncongenital syphilis outcomes. Most mothers were Black/African American (n = 84 [65%]) and lived in areas with a high Social Vulnerability Index. Many had inadequate prenatal care (n = 61 [47%]) and/or had substance use histories (n = 55 [42%]). Significant associations (odds ratio [95% confidence interval]) with congenital syphilis outcomes included limited prenatal care (3.01 [1.38-6.56]), no prenatal care (16.08 [1.96-132.11]), substance use (3.42 [1.61-7.25]), housing instability (3.42 [1.39-8.38]), and justice system interactions (2.29 [1.00-5.24]). Substance use correlated with prenatal care adequacy (P < .001). One-third of infants with congenital syphilis outcomes were taken into protective custody. CONCLUSIONS: Adverse social determinants of health are common in dyads impacted by congenital syphilis. Health systems should consider interdisciplinary programming to improve testing and linkage to care. Future studies should evaluate social support for congenital syphilis prevention and management.

Health care of sexual partners of adolescents with gestational syphilis and their children: an integrative review. / Atenção à saúde dos parceiros sexuais de adolescentes com sífilis gestacional e seus filhos: uma revisão integrativa.

Gestational syphilis (GS) in adolescents is a challenge for Brazilian public health, with high incidence rates. Testing, diagnosis and treatment of sexual partners is essential to interrupt the chain of transmission, but since 2017 it is no longer a criterion for the proper treatment of pregnant women. We sought to analyze and synthesize the knowledge produced about the health care of sexual partners of adolescents with GS in Brazil. We carried out a systematic review in the BVS, SciELO and PubMed databases, selecting articles that addressed GS and/or congenital syphilis (CS) in adolescents aged 15 to 19 years and that included information about sexual partners. Forty-one articles were comprehensively analyzed using the WebQDA software and classified into two categories: a) Approach to sexual partners during prenatal care, and b) The role of sexual partners in the transmission cycle of GS and CS. The studies show that the partner's approach is deficient, with a lack of data on the sociodemographic profile and information on testing and treatment. In the context of Primary Health Care, there are no studies that address factors inherent to the context of vulnerability of sexual partners in relation to coping with syphilis.

A sífilis gestacional (SG) em adolescentes é um desafio para a saúde pública brasileira, com elevadas taxas de incidência. A testagem, diagnóstico e tratamento dos parceiros sexuais é indispensável para interromper a cadeia de transmissão, mas desde 2017 deixou de ser critério para o tratamento adequado da gestante. Buscamos analisar e sintetizar o conhecimento produzido sobre a atenção à saúde de parceiros sexuais de adolescentes com SG no Brasil. Realizamos uma revisão integrativa nas bases de dados BVS, SciELO e PubMed, selecionando artigos que abordavam SG e/ou sífilis congênita (SC) em adolescentes de 15 a 19 anos e que incluíam informações sobre os parceiros sexuais. Quarenta e um artigos foram analisados compreensivamente com auxílio do software WebQDA e classificados em duas categorias: (a) Abordagem dos parceiros sexuais no pré-natal, e (b) Papel dos parceiros sexuais no ciclo de transmissão da SG e da SC. Os estudos evidenciam que a abordagem do parceiro é deficitária, com ausência de dados sobre o perfil sociodemográfico e informações sobre testagem e tratamento. No âmbito da atenção primária à saúde não se encontram estudos que abordem fatores inerentes ao contexto de vulnerabilidade dos parceiros sexuais em relação ao enfrentamento da sífilis.

Gaps in the prevention of mother-to-child transmission of syphilis: a review of reported cases, South Africa, January 2020-June 2022.

INTRODUCTION: Congenital syphilis (CS) is preventable through timely antenatal care (ANC), syphilis screening and treatment among pregnant women. Robust CS surveillance can identify gaps in this prevention cascade. We reviewed CS cases reported to the South African notifiable medical conditions surveillance system (NMCSS) from January 2020 to June 2022. METHODS: CS cases are reported using a case notification form (CNF) containing limited infant demographic and clinical characteristics. During January 2020-June 2022, healthcare workers supplemented CNFs with a case investigation form (CIF) containing maternal and infant testing and treatment information. We describe CS cases with/without a matching CIF and gaps in the CS prevention cascade among those with clinical information. FINDINGS: During January 2020-June 2022, 938 CS cases were reported to the NMCSS with a median age of 1 day (interquartile range: 0-5). Nine percent were diagnosed based on clinical signs and symptoms only. During January 2020-June 2022, 667 CIFs were reported with 51% (343) successfully matched to a CNF. Only 57% of mothers of infants with a matching CIF had an ANC booking visit (entry into ANC). Overall, 87% of mothers were tested for syphilis increasing to 98% among mothers with an ANC booking visit. Median time between first syphilis test and delivery was 16 days overall increasing to 82 days among mothers with an ANC booking visit. DISCUSSION: Only 37% of CS cases had accompanying clinical information to support evaluation of the prevention cascade. Mothers with an ANC booking visit had increased syphilis screening and time before delivery to allow for adequate treatment.

Untreated maternal syphilis has devastating consequences for the foetus. Congenital syphilis (CS) is preventable through timely maternal screening and treatment with robust surveillance. We evaluated CS surveillance data to identify gaps in CS surveillance and in the prevention cascade in South Africa.