Syphilis in pregnancy: A practical guide for prenatal care providers

Syphilis during pregnancy remains a persistent global public health challenge. Untreated or inadequately treated syphilis infection during pregnancy contributes significantly to preventable perinatal morbidity and mortality. In the last five years, a resurgence of syphilis among pregnant women in several regions has led to a concerning rise in congenital syphilis cases. Vertical transmission can occur at any point during pregnancy or delivery, with the highest risk observed during primary and secondary stages of infection compared to latent phases. To align with the World Health Organization (WHO) target of reducing the vertical transmission rate below 0.05%, the International Federation of Gynecology and Obstetrics (FIGO) has developed evidence-based guidance for the management of syphilis during pregnancy. The guidance advocates for universal early screening, strengthened health systems to ensure access to free and timely prenatal care, and the integration of effective follow-up strategies. As early diagnosis and treatment are highly effective in reducing transmission, syphilis screening should begin at the first prenatal visit. While regional protocols vary, at a minimum, screening should be repeated at delivery in countries that have not yet met WHO eradication targets. Benzathine penicillin remains the treatment of choice, with proven efficacy and safety. Additionally, screening and treatment of sexual partners are essential to prevent maternal reinfection and community transmission. Strengthening health systems to support these interventions is fundamental to improving maternal and fetal/neonatal health outcomes and advancing towards global elimination of congenital syphilis worldwide.