Epidemiological and clinical characteristics of gestational and congenital syphilis in Hungary: A cross-sectional, single-center case analysis

BackgroundIn recent years, gestational and congenital syphilis have re-emerged as significant public health concerns in Hungary. Although national surveillance data are available for syphilis, they do not include gestational cases, and recent studies describing the epidemiological and clinical characteristics of gestational and congenital syphilis remain limited. The aim of the study was to analyze 10 years of data to evaluate the clinical characteristics and outcomes of gestational and congenital syphilis and to identify gaps in prenatal screening and care.MethodsWe conducted a cross-sectional, single-center study at the National STD Centre in Budapest, analyzing data from pregnant women diagnosed with syphilis and their newborns between 2015 and 2025. Maternal epidemiological and clinical data were collected, and neonatal clinical and laboratory data were evaluated where available.ResultsA total of 180 pregnant women with 185 pregnancies were included. Diagnosis was made in the second or third trimester in 139 cases, and 110 cases were classified as early latent syphilis. 173 women were asymptomatic at the time of diagnosis. Penicillin was administered in 176 out of 185 (95%) cases, and an adequate serological response, defined as a ≥4-fold decline in RPR titer, was observed in 176/185 (95%). Neonatal data were available for 106 newborns. 10 (9%, 95% CI: 5-17%) neonates met the diagnostic criteria for congenital syphilis, including nine probable and one confirmed case. Clinical manifestations ranged from asymptomatic infection to severe multisystem involvement. All neonates with congenital syphilis (n = 10), as well as those whose mothers had not received adequate treatment (n = 10), in total 20/106 neonates (19%; 95% CI: 12-27%) were treated with penicillin.ConclusionGestational and congenital syphilis remain significant public health concerns in Hungary. The high proportion of late diagnoses highlights the need for repeated antenatal screening and interdisciplinary collaboration to prevent congenital infection.