Free syphilis screening, yet no cure: the gap in managing maternal syphilis in resource-limited primary care

Introduction: Syphilis, caused by Treponema pallidum, remains a significant global health challenge, with 660,000 congenital cases in 2016, causing 200,000 stillbirths. In Indonesia, free syphilis rapid diagnostic tests (RDTs) are integrated into antenatal care (ANC) at primary health centers (PHCs). Case: This case study of a 17-year-old primigravida diagnosed with latent syphilis at 30 weeks of gestation illustrates the consequences of an untreated condition due to drug unavailability. She received only one penicillin dose, leading to confirmed congenital syphilis in her infant through reactive VDRL/TPHA. Loss to follow-up driven by low education and socioeconomic barriers which exacerbated outcomes. Indonesia’s 8.3% syphilis prevalence among screened pregnant women and 60% treatment coverage highlight systemic supply chain failures. Untreated maternal syphilis risks ongoing sexual transmission, particularly in low-education communities with limited health literacy. Conclusion: This manuscript examines the disparity between free screening and inaccessible treatment, proposing solutions like improved penicillin supply chains, community health worker follow-up, and sexual health education to align with WHO’s 2030 elimination goals. Addressing these gaps is critical to reducing maternal and neonatal morbidity in low- and middle-income countries.